Human Rights Watch: Global: Maternal and Reproductive Health Care Failings

Governments Should Improve Response to Grievances, Monitor Progress

May 27, 2010

(New York, May 27, 2010) - Maternal and reproductive health care across the world is often sub-standard and inaccessible, yet many governments are not doing enough to address grievances and track problems, Human Rights Watch said today. Human Rights Watch issued a roundup of its reporting on reproductive health issues in advance of the International Day of Action for Women's Health, on May 28, 2010.

The 10-page roundup, "Unaccountable: Addressing Reproductive Health Care Gaps," illustrates health system accountability failures in Asia, Latin America, Africa, the United States, and Europe. Accountability is a major theme for global efforts to improve maternal health, including those connected to the United Nations-backed Millennium Development Goals and the 2010 G-8 summit meeting.

"Governments have long pledged to reduce maternal deaths and improve reproductive health care," said Janet Walsh, deputy women's rights director at Human Rights Watch. "Yet many aren't taking even basic steps, like enabling patients to lodge grievances, addressing complaints, establishing health standards, and tracking births and deaths."

In interviews around the world, hundreds of women and girls have described the pursuit of reproductive health care as an obstacle course. Logistical, cultural, and financial barriers to services and information, discrimination, and abusive health providers block the way.

Many governments have done far too little to establish functioning grievance mechanisms, Human Rights Watch said. They have neglected to inform patients of their rights and what to do when they are violated. Many women fear retaliation if they complain:

* Women in India told Human Rights Watch that they had never heard of a way to make complaints about maternal health care problems. A few said they had submitted complaints, but were pressured by health professionals to withdraw them.

* In US immigration detention facilities, many women said they were never informed that they could submit grievances about health care problems, and some feared retaliation if they complained.

Many governments lack sufficient standards and guidelines for reproductive health services. In Mexico, for example, most of the federal states have no administrative guidelines on access to legal abortions after rape. As a result, many officials are afraid to facilitate access and deny that they have any mandate to do so.

"Missing or unclear standards hamper efforts to monitor quality of care, and to ensure that health care is available to all who need it," Walsh said. "Accountability is impossible without clear standards."

Tracking health budgets, ensuring independent oversight, and releasing information on health spending to the public are also important elements of accountability, Human Rights Watch said. In many countries, budget allocations for reproductive health are unclear, making it more likely that funds will be misused. Often, the public has little ability to find out where their country's resources are going. In some cases, this lack of openness feeds corruption.

For example, in several Nigerian states Human Rights Watch documented instances in which health funds were squandered or outright stolen. One local government official allocated money to a "fish pond" with neither water nor fish and a "football academy" that he never built, while health clinics crumbled.

Collecting and analyzing data, including registering births and deaths, is another essential element of accountable health systems, Human Rights Watch said, but many governments are neglecting data collection.

For example, the Irish government does not collect data on the number of legal abortions carried out within Ireland, nor does it estimate the numbers of illegal abortions. In India, even though birth and death registration are mandatory, many births and deaths are not recorded. An estimated 26 million births and 9 million deaths occur in India every year, but only 53 percent of births and 48 percent of deaths are registered. Estimates of maternal deaths each year in India range from 60,000 to nearly 120,000, but without better birth and death registration and improved data collection systems, the actual numbers are impossible to know.

"Ignoring grievances and failing to set standards or monitor progress undermines governments' lofty goals for saving lives and promoting reproductive health," Walsh said. "Governments, with support from international donors and agencies, need to do far more to achieve health system accountability."

Human Rights Watch called on governments to:

* Establish accessible grievance mechanisms to facilitate inquiries into maternal deaths and other health system complaints.

* Monitor the provision of reproductive and maternal health care, improve data collection and civil registration systems, and release health data to the public.

* Develop guidelines on reproductive health services and ensure that they are understood and implemented by healthcare providers.

* Ensure that health budgets are sufficiently detailed to allow tracking of reproductive health spending, and make budget information available to the public.

SOURCE

© Copyright 2010, Human Rights Watch

IPPF: Abortion safety key to maternal health: scientists

May 28 2010

The top scientific groups from the G8 countries say funding for maternal and child health, including initiatives aimed at unsafe abortions, must increase.

The Royal Society of Canada and its counterparts in the other G8 countries note that the risk of a woman dying as a result of pregnancy or childbirth is one in seven in the poorest parts of the world and is more than 80 per cent preventable.

A statement from the groups says up to 40 per cent of maternal and infant deaths could be averted with improved access to contraception and measures to reduce unsafe abortion.

The statement says abortions performed by unskilled providers or under unhygienic conditions because of local laws banning abortions account for 13 per cent of maternal deaths.

The Conservative government has excluded abortion funding in its G8 maternal- and child-health initiative.

The scientific groups say governments and inter-governmental and non-governmental organizations must deal openly with unsafe abortions, and ensure appropriate and accessible treatment of women who develop complications.

"Provision of effective contraception for approximately 200 million women who have none would prevent 23 million unplanned births, 22 million induced abortions and 14,000 pregnancy-related maternal deaths each year," the statement, released late Tuesday, reads.

Mortality reduction targets set

The scientific groups also say practices such as female genital mutilation should be eradicated and the misuse of technology of prenatal sex determination for aborting female fetuses should be condemned.

The Royal Society of Canada is the country's senior national body of distinguished scholars, artists and scientists. Its objective is to promote learning and research in the arts and sciences.

The statement says the community shaping global political priorities for the health of women and children has been fragmented.

"G8 governments should work with international agencies to facilitate regional co-ordination mechanisms for women and children's health," it says.

The goal should be reducing child mortality by two-thirds and maternal mortality by three-quarters by 2015.

Documents obtained recently by The Canadian Press through access-to-information show the government ignored the advice of its own civil servants in taking its decision to exclude abortion funding.

Briefing notes prepared in January by the Canadian International Development Agency for International Co-operation Minister Bev Oda suggest access to safe abortion services could save many lives in developing countries.

But appearing before a parliamentary committee Wednesday, two Tory cabinet ministers and CIDA's president offered little insight as to why the government excluded the abortion funding.

CIDA's Margaret Biggs testified that her agency simply provides information, while the government makes the decisions.

Oda supported Biggs's response Wednesday, but refused to say who made the final decision when she was grilled on the issue after leaving the meeting.

Opposition MPs present at the parliamentary committee were not satisfied with Oda's answers.

Leaders of the world's G8 and G20 nations gather next month in Ontario.

Source: www.cbc.ca, 27 May 2010

SOURCE

BBC: SPUC launches legal challenge to abortion guidelines

27 May 2010

Pro-life campaigners have launched a new High Court challenge over controversial government guidelines on abortion in Northern Ireland.

The Society for the Protection of Unborn Children (SPUC) won permission on Thursday to seek a judicial review.

SPUC claims the Department of Health breached an order for complete withdrawal of its guidance.

Abortion is illegal in NI, except where the mother's life or mental wellbeing are considered at risk.

The High Court ruled last year that the advice on terminating pregnancies must be completely withdrawn because it was misleading.

A judge then rejected an attempt by the department to have just two sections on counselling and conscientious objection reconsidered rather than the full guidance.

'No proper consultation'

SPUC have returned to court claiming Lord Justice Girvan's direction has been breached by publishing guidelines with these parts omitted.

The group also alleges there has been no proper consultation with it and other relevant parties.

SPUC originally wanted a declaration that what has been produced did not properly set out the law.

It claimed the guidance also failed to deal with the rights of the unborn child and provided inadequate advice for conscientious objectors within the medical profession.

The Department of Health's legal representatives rejected allegations it had failed to make clear that abortion was illegal in Northern Ireland apart from in the most exceptional circumstances.

They also said the document was for health workers rather than the general public.

Although the High Court stopped short of quashing the guidelines, it ruled last November that the counselling and conscientious objection sections were unclear.

A date for the full hearing of the new challenge has yet to be set.

SOURCE

BBC: Survey suggests easing of Northern Ireland abortion laws

May 26 2010

Abortion laws should be liberalised, more than half of NI's practising gynaecologists have suggested.

An academic survey claims that the majority of gynaecologists in Northern Ireland "do not support the current abortion law as it stands".

Many also said they would carry out abortions under certain conditions.
Sexual health charity FPA said this "rubbished" claims by anti-choice groups and politicians that "there is no place for abortion in NI".

Of 42 gynaecologists working in Northern Ireland, 37 took part in the survey giving a response rate of 88%.

Legal
Fifty-seven percent of respondents said they would support liberalising the current abortion law with more than two thirds agreeing that abortion should be legal on grounds of fetal abnormality.

Asked what conditions under which they would personally carry out abortions, 70% said they would be prepared to on grounds of fetal abnormality and 49% said they would where the woman has been raped.

The survey, 'Attitudes and practice of gynaecologists towards abortion in Northern Ireland' (2009), was conducted by Colin Francome, Emeritus Professor in the Sociology of Health, at Middlesex University, England.

It suggested that: 68% of NI gynaecologists agreed that abortion should be legal when the woman had been raped; 73% wanted free abortions for Northern Ireland women forced to travel overseas for the procedure; and 51% supported major abortion charities being licensed to carry out abortions in Northern Ireland.

Only 32% said the abortion law should stay as it is.

SOURCE

Irish Times: Numbers travelling for abortion drop

ELAINE EDWARDS

Tue, May 25, 2010

The number of women who gave Irish addresses at British abortion clinics decreased for the eighth year in a row last year, new figures show.

Statistics published by the UK Department of Health said some 4,422 women gave Irish addresses at clinics in 2009, down from 6,673 in 2001.

The HSE Crisis Pregnancy Programme said the abortion rate of women giving Irish addresses at clinics has dropped from 7.5 per 1,000 women aged 15-44 (in the UK only) in 2001, to 4.5 per 1,000 women last year (in the UK and Netherlands).

The highest number of those who travelled to the UK for abortions last year were in the 20-29 age group (2,398 women). A total of 38 girls under the age of 16 and 155 girls aged 16 and 17 who had abortions last year gave Irish addresses.

A total of 258 women aged 40 and over also travelled to England and Wales for abortions.

Of those women giving Irish addresses, some 68 per cent terminated their pregnancy at between three and nine weeks gestation.

A total of 18 per cent terminated at between 10 and 12 weeks, 12 per cent had abortions at between 13 and 19 weeks, and 2 per cent terminated at 20 weeks or over.

The Irish Family Planning Association (IFPA) welcomed what it said was the “small reduction” in the number of women travelling for abortions.

IFPA chief executive Niall Behan said: “While this trend is a step in the right direction the harsh reality behind these statistics is that every day 12 women must make the journey to Britain to access safe and legal abortion services.

“These figures are compelling evidence of the need for domestic-based abortion services in Ireland.”

Mr Behan said the Government’s “failure to face reality means that women's and girls' rights are being denied on a daily basis”.

“The criminalisation of abortion has little impact on abortion rates; it merely adds to the burden and stress suffered by women experiencing crisis pregnancies.”

He said that since 1980, at least 142,060 women travelled to Britain for abortion services.

“This figure highlights the hypocrisy of Ireland's laws on abortion, which are among the most restrictive in the world.”

Dr Ruth Cullen of the Pro-Life Campaign said: “Groups advocating abortion in Ireland claim that we need to introduce abortion here to ‘confront the reality of crisis pregnancy’.

“This attitude completely ignores the humanity of the unborn child and the latest peer reviewed research showing the negative consequences of abortion for women,” she said.

“Rather than seek to have abortion introduced in Ireland, we should see the latest reduction in the abortion rate as very encouraging and work together to ensure this downward trend continues.”

Director of the HSE Crisis Pregnancy Programme, Caroline Spillane, noted the “sustained decline” in the number of women giving Irish addresses at abortion clinics in the UK.

“The Crisis Pregnancy Programme along with many other organisations working in the area of sexual health have given strategic focus to initiatives aimed at preventing crisis pregnancy and also to improving the supports which are in place for those who do experience a crisis pregnancy,” she said.

“We hope that these statistics are an indication that this work is having a real impact in reducing the instance of crisis pregnancy in Ireland.”

Last December, the European Court of Human Rights heard a challenge to Ireland’s abortion laws from three women living here.

In the case – known as A, B and C versus Ireland – the women are challenging the State’s abortion laws on the basis that they were forced to travel abroad to terminate a pregnancy which threatened their health or wellbeing. A judgment is expected later in the year.

© 2010 irishtimes.com

SOURCE

RH Reality Check: Nun Excommunicated for Approving Lifesaving Abortion

By Lindsay E. Beyerstein
Created May 19 2010 - 1:30pm

This article was originally published by The Media Consortium [1], of which RH Reality Check is a member.

A nun in Phoenix, Arizona was excommunicated for approving a lifesaving abortion. Sister Margaret McBride [2]'s career in the Catholic church came to an abrupt end after she approved an therapeutic abortion at St. Joseph's Hospital Medical Center, Robin Marty of RH Reality Check reports.

The woman was 11 weeks' pregnant when she developed a life threatening case of pulmonary hypertension [3] according to Ms. Magazine. Sr. McBride approved the procedure after consulting with the patient, her family, and the hospital's ethics committee, but the local bishop excommunicated her anyway.

Sr. McBride's excommunication is the latest salvo in a national battle over access to reproductive health care in Catholic hospitals. Between a fifth and a third of all hospital beds in the United States are administered by the Catholic Church. Catholic hospitals provide health care services to the community at large and often receive public funding—but they are not required to offer treatments that conflict with their religious teachings.

Excommuniqué

Rev. Thomas J. Olmsted [4], Bishop of the Roman Catholic Diocese of Phoenix wrote in a statement, ""If a Catholic formally cooperates in the procurement of an abortion, they are automatically excommunicated by that action." Note that the Catholic Church doesn't automatically excommunicate priests who sexually abuse children.

"We always must remember that when a difficult medical situation involves a pregnant woman, there are two patients in need of treatment and care; not merely one. The unborn child's life is just as sacred as the mother's life, and neither life can be preferred over the other," the bishop wrote.

This wasn't even a choice between the life of the mother and the life of the fetus. An 11-week-old fetus is not viable. If the mother dies, the fetus dies with her. Evidently Bishop Olmestead would rather have seen the woman and the fetus die instead of saving the woman. How pro life.

Radical, even by Catholic standards

Amelia Thomson DeVeaux notes at Care2 that the bishop's position is radical [5] even by Catholic standards:

[N]ow, a dangerous precendent seems to have been established by Olmsted's actions. Olmsted himself is extremely conservative, even by Vatican standards, and has been a strong critic of Obama. But [bioethicist Jacob Appel [6]] claims that this is not really about Olmsted - instead, the decision is reflective of a general trend in Catholic heathcare. Competent adult women, Appel suggests, are no longer allowed to make their own decisions in Catholic hospitals, which comprise approximately 1/3 of medical services in the country.

Liliana Loofbourow passionately rebukes the bishop [7] on the Ms. Magazine blog, "Catholics like Sister Margaret McBride are a ray of hope in the darkness. However, she is not a Catholic anymore. And as of this writing, neither am I."

During the health care reform debate, the U.S. Conference of Catholic Bishops flexed its political muscle to ensure maximally restrictive rules on abortion coverage for everyone. Reproductive rights groups fear that access to basic reproductive health care, and even lifesaving medical treatment in Catholic hospitals will be an ongoing point of contention.

This post features links to the best independent, progressive reporting about health care by members [8] of The Media Consortium [9]. It is free to reprint. Visit the Pulse [10] for a complete list of articles on health care reform, or follow us on Twitter [11]. And for the best progressive reporting on critical economy, environment, health care and immigration issues, check out The Audit [12], The Mulch [13], and The Diaspora [14]. This is a project of The Media Consortium, a network of leading independent media outlets.



SOURCE

Links:
[1] http://www.themediaconsortium.org/2010/05/12/weekly-pulse-scotus-nominee-kagan-a-cipher-on-choice/
[2] http://bit.ly/c9rWIq
[3] http://bit.ly/cTUs94
[4] http://www.azcentral.com/community/phoenix/articles/2010/05/14/20100514stjoseph0515bishop.html#ixzz0oIhkdScL
[5] http://bit.ly/bjk0Q5
[6] http://www.huffingtonpost.com/jacob-m-appel/after-st-josephs-are-wome_b_578086.html
[7] http://bit.ly/aJuqRm
[8] http://www.themediaconsortium.org/our-members
[9] http://www.themediaconsortium.org
[10] http://www.themediaconsortium.org/issues/healthcare
[11] http://www.twitter.com/pulsetmc
[12] http://www.themediaconsortium.org/issues/economy/
[13] http://www.themediaconsortium.org/issues/sustain
[14] http://www.themediaconsortium.org/issues/immigration

New York Times: Poverty and the Pill

By NICHOLAS D. KRISTOF
May 19, 2010

KINSHASA, Congo

Earthquakes are more dramatic. Tsunamis make better television. AIDS is more visceral.

But here’s a far more widespread challenge, one that’s also more fixable: the unavailability of birth control in many poor countries. I’m on my annual win-a-trip journey across a chunk of Central Africa with a 19-year-old university student, Mitch Smith. He won the right to bounce over impossible roads in the region where it’s easy to see firsthand how breakneck population growth is linked to poverty, instability and conflict.

In almost every village we stop in, we chat with families whose huts overflow with small children — whom the parents can’t always afford to educate, feed or protect from disease.

Here in Kinshasa, we met Emilie Lunda, 25, who had nearly died during childbirth a few days earlier. Doctors saved her life, but her baby died. And she is still recuperating in a hospital and doesn’t know how she will pay the bill.

“I didn’t want to get pregnant,” Emilie told us here in the Congolese capital. “I was afraid of getting pregnant.” But she had never heard of birth control.

In rural parts of Congo Republic, the other Congo to the north, we found that even when people had heard of contraception, they often regarded it as unaffordable.

Most appalling, all the clinics and hospitals we visited in Congo Republic said that they would sell contraceptives only to women who brought their husbands in with them to prove that the husband accepted birth control.

Condoms are somewhat easier to obtain, but many men resist them. More broadly, many men seem to feel that more children are a proud sign of more virility.

So the pill, 50 years old this month in the United States, has yet to reach parts of Africa. And condoms and other forms of birth control and AIDS prevention are still far too difficult to obtain in some areas.

America’s widely respected Guttmacher Institute, which conducts research on reproductive health, says that 215 million women around the world are sexually active and don’t want to become pregnant — but are not using modern forms of contraception.

Making contraception available to all these women worldwide would cost less than $4 billion, Guttmacher said in an important study published last year. That’s about what the United States is spending every two weeks on our military force in Afghanistan.

What’s more, each dollar spent on contraception would actually reduce total medical spending by $1.40 by reducing sums spent on unplanned births and abortions, the study said.

If contraception were broadly available in poor countries, the report said, more than 50 million unwanted pregnancies could be averted annually. One result would be 25 million fewer abortions per year. Another would be saving the lives of as many as 150,000 women who now die annually in childbirth.

Family planning has stalled since the 1980s. Republican administrations cut off all American financing for the United Nations Population Fund, the main international agency supporting family-planning programs. Paradoxically, conservative hostility to some family-planning programs almost certainly resulted in more abortions.

The Obama administration has restored that financing, and it should make a priority of broader access to contraception (and to girls’ education, which may be the most effective contraceptive of all).

In fairness, family planning is harder than it looks. Many impoverished men and women, especially those without education, want babies more than contraceptives. As Mitch and I drove through villages, we asked many women how many babies they would ideally have. Most said five or six, and a few said 10.

Parents want many children partly because they expect some to die. So mosquito nets, vaccinations and other steps to reduce child mortality also help to create an environment where family planning is more readily accepted.

In short, what’s needed is a comprehensive approach to assisting men and women alike with family planning — not just a contraceptive dispensary.

Romerchinelle Mietala, a 17-year-old girl in Mindouli, Congo Republic, has one baby and told us that she doesn’t really want another child for now. But she had never heard of contraceptives and, when we explained, was ambivalent. She worried about her status in the village if she didn’t get pregnant again reasonably soon.

“If a woman doesn’t have a baby every two or three years, people will say she’s sterile,” she said.

Another woman in Mindouli, Christine Kanda, said that she is ready to stop now after eight children — two of which have died. But she doesn’t know if her husband will accompany her to the clinic to sign off, and she doesn’t know how she would pay the $1 a month that the hospital charges.

So she may just keep on producing babies.

LINK

Irish Times: Cervical vaccination programme begins

by EITHNE DONNELLAN

Wed, May 19, 2010

A 13-YEAR-OLD student who wrote to Minister for Health Mary Harney last year to complain about the lack of a national cervical vaccination programme has become one of the first to be vaccinated now that the national programme has finally commenced.

Sadbh Scully from Dundrum, Dublin, was among 40 students to receive the HPV vaccine at Jesus and Mary College, Our Lady’s Grove, Goatstown, yesterday.

First-year students at it and 20 other schools are being offered the vaccine before the summer break in the first phase of the national cervical cancer vaccination programme.

Sadbh said she felt very privileged to be among the first to get the vaccine under the national programme.

She wrote to Ms Harney after the death of Jade Goody from cervical cancer saying it was unfair that the vaccine was not being offered to Irish girls. She argued that the vaccination programme could be provided for less than the amount spent on the new Samuel Beckett bridge in the city.

The HSE said the first vaccinations went well, with most students opting to avail of the vaccine, other than those who will be on holiday in July when they will require a second dose.

The vaccine, which protects against 70 per cent of cervical cancer strains, must be given in three doses. The second dose has to be given two months after the first dose and the third six months after the first dose.

Dr Maureen O’Leary, senior medical officer with the HSE, who led the immunisation team at the Goatstown school, said she was happy with the uptake and the response from girls and parents.

First-year students not vaccinated before the summer holidays will be vaccinated when schools return in September. And sixth-class students going into second-level schools in September will also be offered the vaccination at that stage.

About 250 women get cervical cancer each year, and 80 women die from it. The HPV vaccination programme, in conjunction with smear testing, is expected to reduce that death toll in coming years.

© 2010 The Irish Times

http://www.irishtimes.com/newspaper/ireland/2010/0519/1224270654681.html

The Guardian: Abortion Ad Blocked in Northern Ireland

by Henry McDonald, Ireland correspondent
Thursday 20 May 2010 10.24 BST

Channel 4 has banned Marie Stopes advert from being broadcast in Northern Ireland, where abortion is still illegal

Channel 4 has banned an advertisement for abortion services from being broadcast in Northern Ireland.

Millions of viewers in England, Scotland and Wales will be able to watch the TV ad for Marie Stopes International (MSI) on Channel 4 at 10.10pm tonight.

But the UK's fourth channel has been prevented from screening the commercial for MSI in Northern Ireland because abortion is still illegal in the province. Northern Ireland is the only part of the UK where the 1967 Abortion Act does not apply. All of the political parties in the Stormont assembly, except the Progressive Unionists, are opposed to the extension of the act to Northern Ireland.

Anti-abortion groups in Northern Ireland said they welcomed legislation blocking the ad from being broadcast, but they were angry that it would be screened elsewhere in the UK.

A leading sexual health charity based in Belfast said it was another example of how women in the province were treated differently to the rest of the UK.

The Family Planning Association said it highlighted the need to decriminalise abortion in Northern Ireland.

The ad, which is part of the 'Are you late?' campaign by MSI, will air on Channel 4 until the end of June.

Dana Hovig, MSI's chief executive, said: "It's a shame that we are not allowed to screen the commercial in Northern Ireland – abortion continues to be severely restricted there and women in Northern Ireland are forced to travel to England for abortion services.

"Therefore the advertising of abortion facilities, their contact numbers or addresses is against the law in Northern Ireland."

Dr Audrey Simpson, director of Northern Ireland for the Family Planning Association, said: "I think a lot of people would say it is inappropriate to use this ad on television because it would encourage women to have abortions.

"They use the argument that if you give people information it encourages them to go and do something. But women already have access to that information."

LINK

Marie Stopes International: First ever TV commercial for Abortion Services to air in Britain

May 20 2010

Marie Stopes International launches national campaign to raise awareness of sexual health and confront the taboo of abortion

For the first time ever, a commercial for unplanned pregnancy and abortion advisory services will be aired on British television. The commercial, to be screened first on Channel 4 at 10.10pm on 24th May 2010, is part of a new campaign by Marie Stopes International, the UK’s leading provider of sexual health services outside of the NHS.

The ground breaking commercial was created by Marie Stopes International after independent research showed that only 42%1 of UK adults stated that they would know where to go for specialist advice (other than going to their GP) if they or their partner were faced with an unplanned pregnancy. The survey also showed that over three quarters of UK adults (76%)2 agree that commercials about unplanned pregnancy advice services should be allowed on TV within appropriate broadcasting times.

Despite the fact that one in three women will have an abortion in their lifetime3, the subject is still not always openly, or honestly, discussed. While there is a lot of information about abortion available unfortunately not all of it is accurate or impartial. Marie Stopes International works to improve public understanding of unplanned pregnancy and abortion, and to help women make confident, informed sexual health choices.

The campaign asks 'Are you late?' - a question familiar to any woman who has missed her period, and directs women facing unplanned pregnancy to Marie Stopes International’s 24hr helpline, where they can receive non-judgemental support, advice and services. The commercial will air on Channel 4 from May 24th and throughout June.

In 2008, 215,975 abortions were performed in the UK – of which 195,2964 were for women resident in England and Wales. In this same period, 1,173 women were forced to travel at their own expense to England from Northern Ireland, where abortion remains largely unavailable. In 2009, Marie Stopes International performed about one in three of all abortions carried out in England and Wales.

Dana Hovig, Marie Stopes International's CEO said:

"Last year alone we received 350,000 calls to our 24 hour helpline. Clearly there are hundreds of thousands of women who want and need sexual health information and advice, and access to services. Marie Stopes International provides such support in a safe, non-judgemental environment. We hope the new ‘Are you late?’ campaign will encourage people to talk about abortion more openly and honestly, and empower women to make confident, informed choices about their sexual health."

For help and advice, call 0845 300 3737 (24 hours) or visit www.mariestopes.org.uk

For further information, interviews or stills from the commercial, please contact: mariestopes@hillandknowlton.com or call 020 7413 3769/ 3490/ 3764

1 YouGov Plc. Total sample size was 2096 adults. Fieldwork was undertaken between 9th - 11th February 2010. The survey was carried out online. The figures have been weighted and are representative of all UK adults (aged 18+).

2 YouGov Plc. Total sample size was 2096 adults. Fieldwork was undertaken between 9th - 11th February 2010. The survey was carried out online. The figures have been weighted and are representative of all UK adults (aged 18+).

3 Royal College of Obstetricians and Gynaecologists, The Care of Women Requesting Induced Abortion, Evidence-based Clinical Guideline Number 7, September 2004, available at: http://www.rcog.org.uk/files/rcog-corp/uploaded-files/NEBInducedAbortionfull.pdf

4 The Department of Health, Statistical Bulletin, Abortion Statistics England and Wales: 2008, released 21st May 2009, available at: http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_099714.pdf



Marie Stopes International (MSI) is a specialist not-for-profit organisation providing expert and confidential care and support to men and women of all ages in relation to their sexual and health.

It has nine centres across the country delivering services in contraception, abortion, female sterilisation, vasectomy and health screening. It works in partnership with the NHS, supporting over 70 Primary Care Trusts to provide sexual health services.

For further information visit www.mariestopes.org.uk

LINK

Irish Times: Dearth of secondary school sex education highlighted

by ÉANNA Ó CAOLLAÍ

Sat, May 15, 2010

SOME 74 per cent of Irish secondary school pupils received no sex education classes last year, according to a survey published yesterday.

The survey, which found poor implementation of the Department of Education’s sex education programme at senior cycle, “will not make for pleasant reading for policymakers”, Minister for Children and Youth Affairs Barry Andrews said .

The Life Skills Matter – Not Just Points survey, carried out by national youth parliament Dáil na nÓg, measured the implementation of the department’s Social, Personal and Health Education (SPHE) programme and the related Relationships and Sexuality Education (RSE) programme in schools around the country.

The survey found that implementation of “sex education” declines dramatically as the child goes through post-primary school.

Students in first, second and third years are entitled to SPHE, of which RSE is a key component, but there is no dedicated SPHE programme for the senior cycle.

While schools are obliged to continue teaching sex education in senior cycle and all schools should have an RSE policy, the study found that 74 per cent of senior cycle students had no sex education classes in 2009. This compared with 88 per cent of junior-cycle students who had SPHE classes in the same year.

RSE was not timetabled as a class in 85 per cent of respondents’ schools.

Speaking at the publication of the survey in the Department of Health, Mr Andrews said the “core finding” was that inadequate timetabling meant “there simply wasn’t a delivery” of sex education at the senior cycle. He said the report could inform whole school evaluations by the Department of Education.

Alluding to one comment contained in the report where a respondent was critical of the involvement of religious groups in sex education and the claim that “they ridiculed homosexuality”, Mr Andrews said this was “not tolerable in any school, no matter what the religious ethos”.

However, he insisted that a school was entitled to have a religious ethos and if a parent chose to send their child to a school with such an ethos then that had to be respected.

“The balance is a very difficult one to achieve,” he added.

The report found that in 32 per cent of the schools surveyed, sex education was being taught as part of religion class. One-fifth of guest speakers who addressed schools on RSE came from religious groups, according to the survey.

It also found that the most emphasised theme in the sex education syllabus was “healthy relationships”, while the least emphasised theme was “understanding sexual orientation”. It is up to each school’s board of management to decide on teaching priorities in accordance with departmental policy and its own ethos.

The main recommendations include a call to make RSE classes mandatory at senior cycle and for the curriculum to cover a greater range of topics about relationships and sexuality.

SEX AND THE STUDENT: THE REALITY IN CLASSROOMS

“We had a very good system up until the Junior Cert, especially because we had teachers who took it seriously. And then the fact that it’s completely gone in fifth and sixth year is a big hit.”

– Andrew McGahon, 5th year student, Co Louth

“The focus of the education system in Ireland is on the points system. Without points and the Leaving Cert you go nowhere, and I think it’s important to be less focused on that in the future.

“In terms of RSE and SPHE being so important, it includes things that no other subject can teach you on certain life issues. The report states how much young people want to be taught subjects like this. Seventy-six per cent say that they want to be taught RSE or SPHE in schools.

“The only downside of it in our school is that it was taught through religion. Religion is about your spirituality and your moral decisions. I just don’t see how the relevant factual information of RSE can be taught through religion when it has absolutely no relevance and can only but be biased.”

– Ciara Ahern, 6th year student, Tipperary

“What we want is for the parents of tomorrow to be educated so they can help their kids with life skills.”

– Shane Doocey, 5th year student, Cork

“The atmosphere of the class completely changes. It’s more relaxed. The children are more open to discussing personal issues with me. From a pastoral point of view you get to recognise if they are having difficulties in their lives.

“I think it’s very important that they have certain teachers that theyre able to go up to and talk to and be open with.”

– SPHE teacher Carina McEvoy, Clonkeen College, Blackrock

© 2010 The Irish Times

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New York Times: What Every Girl Should Know

By GAIL COLLINS
May 8th 2010

A thousand years ago, popular birth control methods in the Western world included spitting into the mouth of a frog, eating bees and wearing the testicles of a weasel. In Córdoba, Spain, which was supposed to be on the scientific cutting edge, women were told to leap up and down vigorously after sex, and then jump backward nine times.

This is by way of saying that on Sunday we celebrate the 50th anniversary of the birth control pill. We live in troubled times. But let’s give thanks that we avoided the era of the weasel testicles.

Like a great many of our anniversaries, this one is a movable feast. The Food and Drug Administration actually gave G.D. Searle the go-ahead to market the first oral contraceptive (not counting bees) on June 23, 1960. But the F.D.A. announced its intention to approve the pill on May 9, which also happens to be Mother’s Day this year and, therefore, too good to resist.

This is a story about science, and obviously sex. But it’s also a saga about getting information.

American women had been limiting the size of their families long before the pill came along. In the 19th century, the fertility rate was plummeting, and ads for everything from condoms to douching syringes helped keep urban newspapers solvent. My favorite factoid from this period is that a company called National Syringe offered a model with changeable nozzles so it could be used for both birth control and watering plants.

What women did not have was the ability to figure out what actually worked. The powers-that-be believed that the only appropriate form of birth control was celibacy. “Can they not use self control?” demanded Anthony Comstock, the powerful crusader for the Sexual Purity campaign. “Or must they sink to the level of the beasts?”

Comstock managed to get New York authorities to grant him the powers to both arrest and censor, and he bragged that he sent 4,000 people to jail for helping women understand, and use, birth control. He seemed to take particular pleasure in the fact that 15 of them had committed suicide.

One of his targets was Margaret Sanger, a nurse who wrote a sex education column, “What Every Girl Should Know,” for a left-wing New York newspaper, The Call. When Comstock banned her column on venereal disease, the paper ran an empty space with the title: “What Every Girl Should Know: Nothing, by Order of the U.S. Post Office.”

Sanger was the first person to publish an evaluation of all the available forms of birth control. As a reward, she got a criminal obscenity charge. She fled to Europe to avoid going to jail, and her husband was imprisoned for passing out one of her pamphlets. In the end, he got 30 days, and Anthony Comstock got a chill during the trial that led to a fatal case of pneumonia.

It was the courts that eventually gave women the right to not only have access to birth control, but also information that told them what was available and how to use it. (The first big victory had the memorable name of U.S. v. One Package of Japanese Pessaries.) Sanger, meanwhile, helped bring together the wealthy donors and brilliant researchers who would bring forth the first effective oral contraception.

“There’s gonna be some changes made right here on Nursery Hill,” sang Loretta Lynn. “You’ve set this chicken your last time ’cause now I’ve got the pill.”

And we lived happily ever after. Except that over the last 20 years, protests from the social right have made politicians frightened of mentioning birth control and school boards frightened of including it in the curriculum.

Cecile Richards, the president of Planned Parenthood, remembers getting a pretty thorough grounding in sex and the ways to prevent pregnancy when she was in school — back in the days when the raciest thing you saw on television was Rob and Laura Petrie waking up in twin beds on the opposite side of the room. “Kids growing up today watch ‘Gossip Girl’ and all these shows where every teenager is having sex every day — and now we don’t teach sex education in school,” she noted.

Even though 100 million women take the pill every day, to the great relief of 100 million or so of their partners, the terror of mentioning birth control is so great that the humongous new health care reform act has managed to avoid bringing it up at all. Advocates are hoping that when the regulations are finally written, they will require health insurance to cover birth control pills like any other drug. But nobody is sure.

“If the administration would announce tomorrow that all birth control would be free for every woman in America, I think the health care plan would gain 30 points in popularity overnight,” said Richards.

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New York Times: It Started More Than One Revolution

By GARDINER HARRIS
May 3, 2010

The birth control pill has been called the most important scientific advance of the 20th century, and no wonder. Fifty years after its approval by the Food and Drug Administration, it is still one of the leading methods of contraception, in the United States and around the world.

Much has been written about how it revolutionized sexual and social relationships, allowing women to defer pregnancy, enter the work force and make life choices their mothers could not — or, if you prefer, spawning promiscuity and undermining the foundations of marriage.

But the pill also led to profound changes in the F.D.A. itself — a revolution in what Dr. Margaret Hamburg, the current food and drug commissioner, calls regulatory science. Many of the steps that underlie modern drug approvals — extensive clinical trials, routine referrals to panels of outside experts, continuing assessments of a medicine’s safety, and direct communications between the F.D.A. and patients — were pioneered to deal with evolving concerns about the pill’s safety.

In regulatory terms, the pill brought about a kind of reformation: just as Martin Luther insisted that individual Christians could communicate directly with God without the mediation of priests, the pill eventually led the F.D.A. to communicate directly with patients without going through doctors.

That change, fiercely resisted by some physician groups, is now firmly entrenched; the F.D.A. now routinely requires that many medicines carry significant and sometimes complex warnings that patients are expected to read and understand.

But the pill was the first.

“The F.D.A. had been battling with the American Medical Association for years about who would talk to patients,” said Daniel P. Carpenter, a professor of government at Harvard. “And with the pill, the F.D.A. clearly established the upper hand.”

The pill’s role in the maturing of the F.D.A. has often been overlooked because shortly after the agency’s approval of the contraceptive, news of the horrific effects of thalidomide swept the world. That drug had been introduced in Europe as a sedative but was withdrawn in 1961 after it was linked with profound birth defects.

Although thalidomide was never approved in the United States, the horror surrounding its effects led Congress to toughen the drug approval process by requiring manufacturers to prove their medicines were both safe and effective.

It was a standard the F.D.A. had already been putting into effect, quietly if fitfully, in part because of the growing view that the safety of a medicine was inextricably linked with its efficacy.

Enovid, a pill combining the hormones estrogen and progestin, was already being prescribed for menstrual problems. But in approving it as a contraceptive, the agency’s reviewers required Searle to prove that it was effective in preventing pregnancy. (If it worked, the pill would spare women the risks of pregnancy and childbirth, which dwarfed any known risks from the drug.)

So the company undertook one of the most extensive clinical trial programs to date, said Suzanne Junod, an F.D.A. historian. The pill was formally tested in 897 women, mostly in Puerto Rico and Haiti.

The trials were relatively brief and did not answer fundamental questions about risks of cancer, heart disease and other chronic diseases. Uncertain about the long-term effects of hormonal contraceptives, the F.D.A. mandated that doctors limit prescriptions to two years.

The pill’s overwhelming popularity, however, soon rendered this limitation unenforceable. New versions were introduced, so women could simply switch brands — or find another doctor to prescribe the old one. And many doctors ignored the limit anyway.

Then in November 1961, a British physician reported in The Lancet that a young woman had developed a blood clot and died while taking the pill. Within months, two similar fatalities were reported in the United States, and by August 1962, the F.D.A. had received 26 reports of users’ suffering blood clots.

By the end of 1964, more than four million women had used Searle’s pill, and a blizzard of competitors had begun to blanket the market. With something so popular, the agency had no way of knowing if the problems experienced by users were related to the pill or would have happened anyway — the kind of mystery that has plagued drug regulators ever since.

So agency officials did two things for the first time that would eventually become routine. They asked a panel of outside experts to review the evidence on a continuing basis, and they and British regulators pressed for a large epidemiological investigation that would become a model for the future.

Even before the pill, the federal government had a long history of using advisory committees to assess specific subjects and issue reports. But in 1965, the F.D.A. established its first permanent advisory panel, the Obstetrics and Gynecology Advisory Committee, largely to track the safety of the pill. The agency now has 32 permanent advisory committees, one of them with 18 different panels. These committees provide crucial advice not only about whether to approve certain medicines and devices but also how to address safety concerns that arise after approval.

“What the pill does,” said Dr. Carpenter, of Harvard, “is show the F.D.A. that postmarketing surveillance is a tough problem.”

The challenge of communicating these risks to patients while still supporting the product’s continued use bedeviled top agency officials. Protests by women’s groups and hearings on Capitol Hill made clear that despite the agency’s attempts, many women said they took the pill without being fully informed of its risks.

Frustrated that some doctors were not communicating adequately with their patients, the F.D.A. created a handout in 1975 that doctors could use in counseling patients. Many doctors, incensed at what they saw as the agency’s intrusion into the doctor-patient relationship, either ignored the material or refused to give it out.

In 1978, faced with mounting complaints that women did not have the information they needed, the F.D.A. mandated that patients be given the handouts when they picked up their prescriptions at the drugstore.

“It was the first time that the agency had provided information directly to patients at the point of sale instead of relying on physicians,” said Dr. Junod, the historian.

More recently, the Ortho Evra birth control patch has become a telling example of the continuing challenges that the F.D.A. faces in regulating a global, multibillion-dollar industry on which the agency depends for crucial information about drug safety.

Johnson & Johnson developed the patch in hopes of exposing women to even lower doses of estrogen than they got with the pill. But the company’s own studies showed that the patch actually delivered far higher doses.

The finding was buried in a mathematical formula in a 435-page report filed with the F.D.A. The company said it acted responsibly, but after four years, the F.D.A. issued a warning about high estrogen doses, and sales plunged.

One last bit of lore about the pill: no one is even sure when to celebrate its birthday. Ten years ago, the agency honored the occasion on June 23, the date that the F.D.A. gave formal approval for Searle to market the product. This year, the agency is celebrating on May 9, which coincides with the period 50 years ago when it announced its intention to approve the pill when a few technical details were ironed out. That this happens to be Mother’s Day this year may have played a role in the decision.

But whatever the date, it represents the F.D.A.’s first steps into adulthood.

“The pill was a landmark in the field of drug regulation,” said Peter Barton Hutt, a former top agency lawyer. “This is the drug that started it all.”

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