Thursday, September 30, 2010

Medical Independent: IFPA calls for tougher stance on rogue crisis pregnancy agencies

September 30, 2010
Dawn O'Shea

The Irish Family Planning Association (IFPA) is calling on the Government to introduce statutory regulations for all pregnancy advice services which set out minimum codes of practice and standards.

According to the IFPA’s recently released 2009 Annual Report: “Rogue crisis pregnancy agencies continue to operate unchecked in Ireland, causing considerable distress to women who unwittingly attend their services”.

Last year, 18 women attended the IFPA for counselling after a negative experience at the hands of “rogue agencies” and the Association says it is certain that these figures “represent just the tip of the iceberg”.

Women attending the IFPA described being “harassed, bullied and being given blatantly false information” by these agencies.
The IFPA also voiced its concern surrounding the difficulty experienced by women with travel restrictions in accessing safe and legal abortion services abroad.

Women, such as those seeking asylum or migrant workers, seeking a termination abroad must apply for a visa from the country to which they will be travelling as well as a re-entry visa for Ireland.

According to the IFPA, the process of applying for these travel documents is “complex, expensive and can take several weeks”.
Combined with the financial cost of accessing a termination abroad, such situations may force women to parent against their will or to resort to illegal methods to terminate their pregnancies in Ireland, the Association said.


Inter Press Service: Activists File Writ of Habeas Corpus – for Legal Abortion

Date: September 28, 2010
Author: Marcela Valente

BUENOS AIRES, Sep 28 (IPS) - Heartened by the passage of a same-sex marriage law in Argentina, women's organisations in this South American country stepped up their demands for the legalisation of abortion, on the Day for the Decriminalisation of Abortion in Latin America and the Caribbean.

Some 1,000 members of the Juana Azurduy Women's Collective, better known as Las Juanas, filed a "collective and preventive" writ of habeas corpus at different courtrooms around the country, demanding that the criminalisation of abortion be declared unconstitutional.

They also asked the courts to press the legislature to bring the law that penalises abortion into line with international norms that recognise a woman's right to make decisions about her body.

"We chose the habeas corpus route because it protects people's freedom, and we are thus asking the courts, in a preventive manner, to protect us if we become pregnant and want to interrupt the pregnancy," Las Juanas activist Gabriela Sosa told IPS.

Sosa, who is head of the organisation in the eastern province of Santa Fe and is one of the women who signed the writ of habeas corpus, said the present political and social climate in the country lends itself to making progress towards a law that would decriminalise abortion.

"Not long ago we could not imagine that Argentina would have a same-sex marriage law, and this year it was achieved because there is social concern and interest in debating these issues, and the politicians are picking up on and reflecting that," she said.

But she admitted that the 2011 elections are an obstacle, because "no candidate is going to want to pick up the hot potato of abortion" in a campaign year.

In Argentina, abortion is a crime punishable by prison, except in cases where the pregnancy is the result of rape, the expectant mother's life is in danger or she is mentally ill or disabled.

But every year some 460,000 to 600,000 women resort to abortion in this country of 40 million people, according to the report "Estimate of the Extent of the Practice of Induced Abortion in Argentina", prepared by experts from the University of Buenos Aires and the Centre for Population Studies.

In Latin America, abortion is only legal in Cuba, Puerto Rico and Mexico City. With the exception of Chile, El Salvador and Nicaragua, where abortion is illegal under any circumstances, in the rest of the countries in the region "therapeutic" abortion is legal in certain cases, such as rape, incest, fetal malformation or risk to the mother's life.

Nevertheless, more than four million illegal abortions a year are practiced in the region, according to different sources, and 13 percent of maternal deaths are caused by abortion-related complications.

In Argentina, unsafe abortions are the main cause of maternal mortality, the Juana Azurduy Women's Collective reports.

Against that backdrop, Las Juanas presented their legal action on Tuesday Sept. 28, observed as the Day for the Decriminalisation of Abortion by the women's movement in Latin America and the Caribbean since 1990.

The London-based Amnesty International joined its voice to the campaign. The deputy director of the rights watchdog's Americas Programme, Guadalupe Marengo, called for the repeal of all laws that penalise or provide for the imprisonment of women or girls who undergo an abortion under any circumstances.

Amnesty said the restrictions on safe, legal abortion put the human rights of women in the region in "grave danger."

For years, women's groups in Argentina have been campaigning for the decriminalisation of abortion, but have continually run up against the fierce resistance of the powerful Catholic Church and other conservative sectors of society.

However, this year the situation looks more favourable. Since March, the lower house of Congress has been studying a draft law that would decriminalise abortion, which has the backing of around 50 lawmakers from different parties.

The bill, which may be debated in October, was introduced by Cecilia Merchán, a legislator with the left-wing movement Libres del Sur, and would legalise first-trimester abortion on demand, similar to the law in effect in the Federal District of Mexico City.

None of the nearly 20 earlier bills on abortion introduced in the Argentine legislature over the years progressed. But the current draft law has already made it through several committees and is on its way to a full session debate in the lower house.

Merchán told IPS that the bill she sponsored is in response to the large number of abortions practiced in this country, and especially to the fact that more than 70,000 -- mainly low-income -- women are hospitalised annually for complications from unsafe abortions.

"Last year, 120 of the women admitted to public hospitals with abortion-related complications died: in other words, every other day, a woman dies in Argentina due to this cause," she said.

The lawmaker said "the present climate is favourable" to moving forward on the issue because "society has raised the need for Congress to address a question that has severe consequences for the lives of so many women.

"Just like in the case of the debate on same-sex marriage, society as a whole, even those who are opposed, don't want to keep hiding a reality that involves so many people," she said.

"For us, this is not a new issue, but we see that society's demands are now forcing legislators to discuss it," she added. There have also been declarations on the issue by sectors that in the past have been reluctant to take a public stance, like public universities. The deans of the University of Buenos Aires, for instance, backed the decriminalisation of abortion by 23 votes against one, in August.

In addition, there have been statements in favour by members of the Supreme Court, like magistrate Carmen Argibay, who said this month that the time to debate changes in the country's abortion law "is now."

However, while the legislators are preparing their offensive in the lower house, another bill has been presented in the Senate, which would merely expand the circumstances under which therapeutic abortion is legal.

The idea underlying the initiative by several women senators is that legal abortion would also be made available to women facing risks to their health, a concept that would be broadly defined as physical and mental health.

The women's organisations do not have the support of President Cristina Fernández, who has spoken out against the legalisation of abortion. But Merchán is confident that the president's position will not impose itself in the legislative debate.


Wednesday, September 29, 2010

Irish Medical Times: Research needed on illegal abortion in Ireland

September 29, 2010

Dear Editor,

I’d like to echo Dr Ruairi Hanley’s call for a referendum on the introduction of abortion facilities in Ireland, broadly similar to those in the UK (‘Addressing the great taboo’, IMT, September 10).

This would make a big difference to the rising problem of illegal abortion in Ireland. It would also make a huge difference to Irish obstetricians who have to cope with the extraordinary difficulty of not being able to provide termination on clinical and social grounds here in our own hospitals.

I hope that the medical community will continue to provide a strong voice to advocate for a modernisation of our reproductive laws in Ireland.

I also feel that research into the growing problem of illegal abortion would be a useful tool in assessing this need for legal change from a clinical point of view, because until now illegal abortion in Ireland has not been well documented and it remains a secret and covered-up problem with severe clinical consequences.

The maternity and emergency departments should be encouraged and provided with adequate funding to explore this cause of maternal morbidity and mortality as a matter of urgency.

Dr Juliet Bressan,
Amiens St,
Dublin 1


Tuesday, September 28, 2010

Huffington Post: New Global Maternal Mortality Data Offers Hope

Anika Rahman
President, Americans for UNFPA

Posted: September 15, 2010 10:04 AM

Today, along with advocates and women around the world, I feel a moment of triumph at the news that maternal death has declined by one-third globally.

According to a new report, Trends in Maternal Mortality released by the United Nations Population Fund (UNFPA), World Health Organization (WHO), the United Nations Children's Fund (UNICEF) and the World Bank, "the number of women dying due to complications during pregnancy and childbirth has decreased by 34% from an estimated 546,000 in 1990 to 358,000 in 2008."

For the last few years, I've relied on the staggering statistic that every minute a women dies in pregnancy and childbirth to draw attention to the dire struggle endured by women around the globe. The number has always stopped people dead in their tracks. For the first time in a long time, I can look down at my watch when the minute hand turns and think of something other than a woman needlessly losing her life.

While this progress is notable, the reality is that the current annual rate of decline in maternal death is less than half of what is needed to achieve the Millennium Development Goal - a gold standard for our collective global development objectives - target of 75% reduction in maternal death by 2015. Still, the new data shows that progress and maternal health is achievable, and it fuels my desire to increase U.S. efforts and involvement to improve maternal health globally.

In Africa and South Asia, complications during pregnancy and childbirth are one of the leading causes of death for women of childbearing age. I wonder how many people are aware of the frequency and pervasiveness of maternal mortality throughout the world.

So many articles come across my desk in a given week, but when I saw an article in the Hindustan Times I was particularly moved by the headline which read, "She gave birth, died. Delhi walked by." This article reveals the tragic story of a woman who gave birth on the side of a busy road in Delhi, India. The unnamed, unaided woman died shortly after giving birth because of lack of medical care. The article narrates how thousands of people on foot, on bicycles and in cars must have passed this woman as she gave birth. Sadly, no one noticed because this is the norm in regions throughout the world where reproductive healthcare is a privilege and not a right. Just four days later the new mother died on the side of the busy road, in the same location where she gave life.

The void that is created when women die during or after childbirth is inescapable. Children are left motherless, husbands are left without their wives, and communities are left without matriarchs. This tragedy is not limited to Delhi, India. There are countless women throughout the world who are left to face the reality of no access to reproductive healthcare.

I am reminded of women like Veronica Komba from Tanzania, whose story was recently featured in UNFPA's Mothers Saved. At the age of 14, Veronica was left homeless, hungry and pregnant. She came very close to death after collapsing in her village from high blood pressure, but her life was spared, primarily because she was able to access transportation to a hospital. A local women's group paid for the vehicle that transported Veronica 60 km to the nearest hospital for the C-Section that saved her life.

Giving birth is especially risky in South Asia and Sub-Saharan Africa, where most women deliver without any access to skilled care. It doesn't have to be this way. With greater access to perinatal care, most maternal deaths could be avoided. We can live in a world where no woman dies in childbirth.

By endorsing the Millennium Development Goals ten years ago the U.S., together with 187 other countries worldwide, made a joint promise to women worldwide to reduce maternal mortality and ensure universal access to reproductive healthcare by 2015. On September 20-22, the Millennium Development Goals Summit will be held in New York to examine the progress being made on each of the goals to date. While progress is being made overall, the goal of improving maternal health lags behind others. As we draw nearer to 2015, it is evident that there is still work to be done.

1,000 women are dying every day and 20 times as many become ill or injured because of a lack of access to healthcare during their pregnancies and childbirth. Continuing to shed light on this issue is imperative. We at Americans for UNFPA urge you to join our Call to Action by signing on to our petition requesting that the U.S. honors its commitment to improving maternal health and implementing universal access to reproductive healthcare by 2015. Don't let another woman die giving life.

Join me in calling for the Obama Administration to put women's health and MDG 5 at the heart of U.S. government's global priorities over the next 5 years.

Join Americans for UNFPA for a tweet chat on MDG 5 from 3-4pm EST on Tuesday September 21st, using hash tag #mdg5.


Irish Aid: Report on Ireland's contribution towards achievement of Millennium Development Goals

Download report, factsheets and other news relating to the UN MDG Summit (September 2010) here.

Irish Times: Increase in single fathers opting for vasectomy

Health Correspondent

Wed, Sep 22, 2010

THE NUMBERS of single men opting for vasectomy has increased over the past decade, according to the latest annual report from the Irish Family Planning Association.

The single men seeking the procedure had all fathered children.

Dr Caitriona Henchion, medical director of the association, said the men, mainly in their 30s and 40s, were supporting children they had had in a relationship, but did not want to take on the financial burden or responsibility of any more “and were even cagey about new relationships” as a result.

The association, along with releasing its annual report for 2009 yesterday, published the findings of a survey of men who opted for vasectomy in the last 20 years.

More than 3,000 vasectomies were carried out by the association over that period. A review of 328 of the cases found the procedure had been most popular among couples in their 30s with two or three children.

“Vasectomy is seen by many men as a way of removing the contraceptive burden from their partner when their family is complete . . . It has become a very acceptable choice thanks to some brave men who broke the taboo and spoke about their own experience of vasectomy, such as the recently deceased broadcaster Gerry Ryan,” Dr Henchion said.

The number of single men opting for vasectomy is still small overall. The association report says that in the 1990/1991 period its clinics had no vasectomy clients who said they were single. By 1998/1999 2 per cent of 180 clients described themselves as single, increasing to 8 per cent of 106 clients in 2007/2008.

Asked about the fact that there were fewer men seeking the procedure at association clinics in 2007/2008 than 10 years earlier, Dr Henchion said she believed this was because the service was now widely available through GPs.

Meanwhile, the association’s report indicates it had to refuse appointments to about 3,000 medical card patients last year due to a cut in funding from the Health Service Executive.

Those who could not be accommodated were referred back to their GP. The association said this was entirely unsatisfactory, given that clients were referred to it by their GP, or sought association services because their GP would not or could not provide a comprehensive family planning service.

Dr Henchion said association clinics had funding only to see a certain number of medical card holders each month.

The annual report reveals 18 women attended association clinics for counselling last year after negative experiences at the hands of rogue agencies claiming to provide crisis pregnancy counselling.

The report said the association was certain the figures represented “the tip of the iceberg”.

The association was urging the bringing forward of statutory regulation for all pregnancy advice services, prescribing codes of practice and standards, the report said.

© 2010 The Irish Times


Irish Medical Times: Abortion should be part of 'best practice' in medicine

Dear Editor,

It was with surprise that I read Dr Ruairi Hanley’s article ‘Addressing the great taboo’ (IMT September 10, 2010).

He claims that it has taken him six years to summon up the courage to address the subject of abortion; he goes on to describe it as “the most contentious subject in Irish medicine”. He fears “irrationality and base hostility”, claiming they are part and parcel of an engagement with the issue; he even anticipates “hate mail”!

Having ventured into the area, he then criticises the pro-choice movement for allegedly concentrating on rare and emotive abortion cases. On the contrary, surely? As a founder member of Doctors for Choice — an organisation representing Irish doctors who support a woman’s right to choose abortion, seeing it as an integral part of her right to self determine her bodily integrity — we have consistently asserted that the key issue is the approximate 5,000 Irish women who travel each year to access abortion abroad. There is nothing ‘rare’ in these numbers.

It is variously estimated that between one in ten and one in fifteen Irish women of reproductive age have had an abortion. These women are our everyday patients. We are likely to meet them in our consultations at least once a day, yet don’t know who they are. These many thousands of women, as well as being our patients, are also our friends, our sisters and our children. This is the reality of abortion in Ireland.

It needs to be acknowledged that Irish doctors have been complicit in the silence surrounding the subject of abortion in this country. It is indeed time to end that silence. To this end, Doctors for Choice welcomes Dr Hanley’s (somewhat belated!) writing on abortion and his request for a rational discussion by Irish doctors; this debate is indeed urgently needed.

However, we would stress that the debate should remain firmly focused on the many, many thousands of Irish women who have had and continue to have abortions. A focus on patient autonomy, patient safety and equity of access to services must be at the heart of the debate. These values are also at the heart of best practice in medicine; it is time to include abortion as part of that best practice.

Dr Mary Favier,

Doctors for Choice


Guttmacher Institute: New study finds abortion does not cause mental health problems among adolescents

125 Maiden Lane, 7th Floor, New York, NY 10038
Ph 212 248 1111 Fax 212 248 1951

Rebecca Wind

Friday, September 24, 2010

Teens who have abortions are no more likely to become depressed or have low self-esteem than their peers whose pregnancies do not end in abortion, according to “Do Depression and Low Self-Esteem Follow Abortion Among Adolescents? Evidence from a National Study,” by Jocelyn T. Warren of Oregon State University et al., which is available online and will appear in the December issue of Perspectives on Sexual and Reproductive Health. The study found that the factors most closely linked with depression and low self-esteem after abortion are having experienced those problems in the past.

A 2008 study by the American Psychological Association (APA) found no evidence that induced abortion causes mental health problems in adult women, but because of a scarcity of evidence on teens, no conclusions were drawn at that time about the impact on adolescents. The new study is the first to look at depression and low self-esteem as potential outcomes of abortion among a nationally representative group of teens, and the results are consistent with the findings of the earlier APA report—induced abortion does not cause mental health problems in adolescent women.

While 34 states currently require that women receive counseling before an abortion is performed, seven of these states specifically require that women be warned of possible negative psychological consequences resulting from the procedure. “Paradoxically,” the authors of the new study suggest, “laws mandating that women considering abortion be advised of its psychological risks may jeopardize women’s health by adding unnecessary anxiety and undermining women’s right to informed consent.”

The study is based on data from the 289 respondents to the National Longitudinal Study of Adolescent Health who reported at least one pregnancy between the survey’s first two waves, 69 of whom reported an induced abortion.

The article is currently available online and will appear in the December 2010 issue of Perspectives on Sexual and Reproductive Health.


Think Pro Choice!

Calgary Pro-Choice Coalition has produced a fabulous and fun comic to counter an anti-choice misinformation campaign going on in Canada. Download the comic here!

Guttmacher Institute: The impact of medication abortion ten years after FDA approval

September 27, 2010

On September 28, 2000, the U.S. Food and Drug Administration (FDA) approved the use of the abortion drug mifepristone (in combination with a second drug, misoprostol) as an alternative to surgical abortion for terminating early pregnancies. In the decade since, use of early medication abortion has expanded substantially, with growing numbers of providers offering the service, and its approval has given many women a choice between medication or a surgical procedure when seeking an early abortion.

Both the number of medication abortions and the number of providers offering them increased dramatically between 2000 and 2007, even as the total number of abortions performed in the United States declined. In 2007, 158,000 medication abortions were performed using mifepristone, accounting for an estimated 21% of all eligible abortions (those performed prior to nine weeks’ gestation) that year. Preliminary figures suggest use of mifepristone has continued to grow 10–15% annually since 2007.

Although the introduction of mifepristone did not increase the overall incidence of abortion, it does appear to have contributed to a change in the timing of women’s abortions. A larger proportion of abortions take place at earlier gestations than they did before the drug was introduced. The Centers for Disease Control and Prevention report that although the proportion of women obtaining abortions in the first trimester has remained stable, the proportion of abortions obtained at nine weeks’ gestation or earlier has increased, as has the proportion obtained within six weeks’ gestation.

Prior to FDA approval, medication abortion was described as having the potential to change the nature of abortion provision in the United States. Abortion was expected to become more broadly available, particularly in rural areas without a surgical abortion provider. However, Guttmacher research published last year found that while use of mifepristone has become widespread—and has contributed to the shift toward earlier abortions—it has not substantially improved women’s geographic access to abortion services. Most medication abortions are provided at or near facilities that already offered surgical abortions.

Click here for more information:
Facts on Induced Abortion in the United States
The incidence of abortion in the United States
The effect of mifepristone on abortion access


Irish Examiner: Mentally disabled women try to hide pregnancies

By Juno McEnroe
Saturday, September 25, 2010

WOMEN with intellectual disabilities often experience negative attitudes from those close to them, as well as from service providers, when they become pregnant and may even try to keep their pregnancy secret, according to a report.

The report looked at research on challenges faced by people with intellectual disabilities in relation to crisis pregnancies.

Current Irish legislation criminalises specific sexual acts, including intercourse, among people who are "mentally impaired" unless they are married to each other.

The report calls for better support and education for people with intellectual disabilities and also warns they are particularly vulnerable to sexual abuse.

The findings of the Crisis Pregnancy Programme research are expected to help guide changing legislation on mental capacity.

There are some 50,400 people diagnosed with an intellectual disability living in Ireland, 40% of whom are women.

Health professionals met at a Dublin seminar yesterday to discuss the findings, as well as best international practice in assessing people’s capacity to access medical treatment and sexual relationships. According to researchers, paid carers or relatives already make decisions on behalf of women with intellectual disabilities in the area of reproductive health. Many children of those people are also often placed in care.

The Government’s proposed Mental Capacity Bill, originally published in 2008, suggests that there should be a presumption of mental capacity in a person and that they should not be treated as being unable to make a decision unless all practical steps have been exhausted. This also includes when it comes to decisions about medical treatment.

This story appeared in the printed version of the Irish Examiner Saturday, September 25, 2010


Irish Independent: Cervical cancer jab offer for older girls

By Eilish O'Regan
Health Correspondent
Tuesday September 28 2010

OLDER schoolgirls who will miss out on the free cervical cancer vaccine being rolled out by the HSE are being offered the jab for €300.

The Health Service Executive (HSE) is currently giving the first phase of the vaccine to schoolgirls in first and second year of secondary school.

However, health insurer Aviva yesterday announced its own catch-up programme in partnership with Point of Care.

It aims to make the vaccine available to 150,000 girls between third and sixth year of secondary schools. It said that 29 schools with more than 11,000 pupils had already expressed an interest.

"A number of schools in Dublin, Cork, Meath and Limerick have already signed up to the programme and vaccinations will begin this month."

The cervical cancer vaccine is offered free of charge by the HSE -- but only to girls in the first two years, and from 2011 will only apply to first years.

This scheme is costing €3m for 30,000 secondary school girls this year -- at a cost of around €100 per child.

In contrast, receiving the vaccine privately through a GP is estimated to cost around €600.

The catch-up scheme offered by Aviva will target older girls who are still teenagers but are too old to qualify for the free vaccine.


Aviva said it was offering the set of three injections at the "lowest price for vaccination in the country" -- it will work out at €300 per student where a group of 25 are involved. It will be cheaper for its own members at €249.

It said a recent survey of parents in second to sixth year of secondary school had shown that 93pc thought it would be a "good thing" for their daughter to receive the vaccine.

Up to 13pc said their daughter had already received it.

However, more than half (51pc) were not willing to pay for the vaccine saying it was too expensive.

Caroline O'Reilly is principal of Eureka Secondary School, Kells, Co Meath, one of the first schools to sign up to the programme. "We were getting lots of requests from concerned parents who had daughters who did not qualify for the Government's programme.

"We are now one of the first schools in Ireland to offer our 400 girls from third to sixth year access to this vaccine through the Aviva Schools Catch Up Programme, which will help protect their future health."

- Eilish O'Regan Health Correspondent