A Supreme Threat on Reproductive Freedom
I consider myself an advocate for reproductive rights. I have my monthly donations set up to Planned Parenthood, and like many other women in America, I was galvanized by the 2016 election and what a President Trump would mean for our future. But until this week, I never really thought seriously about the possibility of losing the right to make the reproductive choices that are right for me. Now, the reality of a permanent and legal barrier to reproductive choices for all women in America seems very real.
With President Trump’s appointment of conservative Supreme Court Justice Gorsuch, and the news that Justice Kennedy will be retiring at the end of the summer, there is a strong possibility that the national fight over access to abortion will be re-ignited. Anti-abortion groups say they see an opening for overturning Roe v. Wade if Trump nominates another conservative anti-abortion rights justice who would vote in their favor, should abortion cases make it to the high court.
Since the beginning of 2017, the Trump administration has enabled an environment of attacks on reproductive rights both internationally and abroad. The impacts of the reinstatement of Global Gag Rule are beginning to emerge: some projections say that approximately two million women will be denied sexual and reproductive health services as a result of the order. This year, states like Iowa and Mississippi have passed the strictest abortion limits in the United States. Abstinence-only education is being championed, and more employers who cite moral or religious reasons are being allowed to opt out of no-cost birth control for female workers. The administration has made attacks on Planned Parenthood and on affordable healthcare a cornerstone of its agenda since day one. These assaults on reproductive rights have predominately affected low-income women and women of color; it is a privilege that I have always had affordable health insurance which has given me the freedom to make my own reproductive choices.
As I contemplate how we can combat this threat and protect our bodies and our rights, I’ve been thinking of the parallels between the political battle for reproductive rights in the U.S. and the work I do as a Global Health Corps fellow at Jhpiego Uganda. In Uganda, the unmet need for family planning is 32% among unmarried women, and 28% among married women. This means that of the women who actively want to use a family planning method, on average 30% of them are not able to do so. In other words, nearly one in three women want to have reproductive control over their bodies but cannot because of barriers to access. Family planning contributes to preventing the spread of HIV, lowering infant and maternal death, and reducing unwanted pregnancies, which comprise 43 percent of all pregnancies nationwide.
High adolescent fertility — 25% of adolescents age 15–19 have begun childbearing — affects Uganda’s population in a myriad of ways. Children born to young mothers are at an increased risk of sickness and poor health. Pregnancy during adolescence presents grave risks to a girl’s health and wellbeing; almost one out of every three teenage girls in Uganda drops out of school because of pregnancy. And complications of pregnancy, unsafe abortions and childbirth are the leading causes of death and disability among Ugandan women 15–19 years.
One of the programs I’ve worked with this year is an adolescent health program in Eastern Uganda, where we’ve trained teenage mothers as adolescent peer guides to support other pregnant adolescents by providing sexual and reproductive health information and helping them access health facilities. The program also addresses the social stigma facing adolescents by training health providers in providing adolescent-friendly care. Many health programs focus on prevention of first pregnancy, but this program was unique in targeting already pregnant girls and adolescent mothers. These peer guides have reached over 4,000 girls in their communities through home visits, and the project saw an increase in adolescents initiating family planning.
There are a range of factors and barriers in a developing country like Uganda that limit access to family planning. Lack of information leads to dangerous misconceptions and social stigmas, such as rumors that IUDs cause cancer or infertility. In patrilineal societies like Uganda, men are oftentimes the decision-makers when it comes reproductive choices, and women do not always feel safe or free to seek family planning methods on their own. Health workers are often lacking the proper skills to provide services, especially in provision of long acting reversible contraceptives. Other issues include stock out of family planning commodities, equipment and supplies, and women’s inability to access a facility close to their home. Many of these factors are compounded by barriers at the national policy level, where there has been a controversial reluctance to expand resources and health programming to adolescents despite high rates of unplanned pregnancy among this population.
A government’s stance on reproductive rights has very real consequences on its population, whether in Uganda or in the United States. Currently, more than 200 million women in developing countries desire to space or limit pregnancies; however, they lack access to family planning options. There are many organizations both domestically and globally which are doing important work — Planned Parenthood Action Fund, International Women’s Health Coalition, Center for Reproductive Rights, and more — and they need our support. Family planning not only improves maternal and child health and survival, but also increases the economic well-being of individuals, families, communities, and nations, and empowers women while promoting human rights for all citizens. It is our job to hold our governments accountable in ensuring that quality sexual and reproductive health services, including access to a full range of safe family planning options, are available for all.
Alex Kloos is a 2017–2018 Global Health Corps fellow at Jhpiego in Uganda.
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