In India, at least 15 women have died in government-run clinics due to complications from botched sterilization surgery. Many more are in the hospital. These tragedies are the latest consequence of India’s state-sponsored sterilization program, in which women are offered payments in exchange for consenting to an invasive—sometimes dangerous, even fatal—procedure. For low-income women trying to meet expenses, these financial incentives can amount to a coercively high degree of pressure to undergo the surgery. The practice has unmistakable roots in colonialism, as well: For years, activists have criticized Britain for funding reportedly dubious sterilization practices in India, including threatening women with the loss of their benefits, lying to them about the nature of the operation, and leaving patients in pain without any kind of aftercare.
Coercive or forcible sterilization is an epidemic worldwide. When it does receive attention, though, it’s usually in the wake of horrific events like those in India, or in investigations like the Center for Investigative Reporting’s exposé of mass unlawful prison sterilizations earlier this year. But as a continuing issue, the quiet, day-to-day use of sterilization as a weapon to infringe upon reproductive rights—including in the United States—rarely bubbles up into the public consciousness.
In the midst of the cone of silence surrounding sterilization, there’s an epicenter: Disabled people with significant impairments who are at the whims of doctors, guardians, and courts when it comes to their reproductive rights. That is slowly starting to change. Earlier this month, a group of Australian disability rights activists demanded an investigation from the United Nations into why at least 47 disabled Australians were forcibly sterilized by court order between 2004 and 2014. Reproductive rights activists worldwide should take a lesson here: In a landscape where everyone should have the ability to take personal control of her own fertility, they must acknowledge and confront the historical and continuing sterilizations of disabled people. In the process, advocates must take an intersectional approach to address concerns about other vulnerable groups also targeted for sterilization.
The UN considers forcible sterilization to be a form of torture, pointing to a growing body of public opinion and legal cases. The UN’s report on the issue, released in February 2013, specifically noted that disabled people are often targeted for sterilization and articulated why forced sterilization is so damaging to reproductive and personal freedoms:
Forced sterilization is an act of violence, a form of social control, and a violation of the right to be free from torture and other cruel, inhuman, or degrading treatment or punishment. The mandate has asserted that ‘forced abortions or sterilizations carried out by State officials in accordance with coercive family planning laws or policies may amount to torture.’
A detailed report from the Washington College of Law concurred with these findings, noting, again, that disabled people are common targets for coerced sterilization. Some of the earliest eugenics programs in the United States, Germany, and other regions focused on sterilizing “defectives” so they couldn’t reproduce; such programs eventually expanded to include low-income people and people of color. Well into the mid-century, the Supreme Court and numerous appellate courts continued to affirm the validity of the coerced sterilization of disabled people at the behest of their guardians, who were often government-run residential facilities.
In numerous states, laws regarding sterilization for reasons of disability still remain on the books. These policies are not simply holdovers from a previous era, however. In 1993, a mentally ill patient was sterilized by court order, with a later court upholding the judgment on appeal. Five years later, a Michigan court approved a request for sterilization in the case of Lora Faye Wirsing, who had developmental disabilities, at the request of her guardian. And the horrific “Ashley Treatment” got a pass from a bioethics committee in 2007. In that treatment, surgeons removed a girl’s uterus and breast buds, while she was put on growth-stunting medications to keep her small, on the grounds that she would pose a “hardship” to her family as she matured. That procedure has been used on multiple children in the subsequent years.
All of these cases highlight the fact that disabled children and young adults continue to be sterilized as a matter of convenience. In turn, this reflects the social attitude that some disabled people should be sterilized “for their own good,” or with the goal of preventing difficulties with their care—in court, for example, lawyers have argued that developmentally disabled adults can’t care for their children, or that people with significant cognitive disabilities may not fully understand sexuality and reproduction.
These situations have prompted dismay from the medical community as well as disability rights activists. In 1999, the American Academy of Pediatrics provided official clinical guidance on the subject, cautioning against sterilizing patients without considering alternatives. Eight years later, the American College of Obstetricians and Gynecologists spoke out on the issue, saying, “The presence of a mental disability does not, in itself, justify either sterilization or its denial”; Human Rights Watch noted in 2011 that sterilization continues to be a global problem. And in 2012, the National Council on Disability specifically addressed its looming concern: “Equally alarming, a growing trend is emerging toward sterilizing people with intellectual or psychiatric disabilities.”
Yet, for the most part, cases like these remain largely out of the public eye. In the last few years, one of the only mainstream media outlets to interrogate the forced sterilizations of disabled people has been Al Jazeera, whose writer, Lori Jane Gliha, interviewed a nurse who oversaw potentially thousands of such procedures in Virginia. Another rare example of detailed reporting comes from the Winston-Salem Journal, which did an exhaustive multi-part piece on the subject beginning in 2002. As evidenced by those stories, there is a wealth of archival material, first-hand narratives, court transcripts, and other research to draw upon about this topic. Even so, politicians’ and the media’s paltry coverage of the nation’s history of eugenics leaves much of the public ignorant of these injustices. As Raquel Reichard noted at Mic, coerced sterilization is a moot subject even at many feminist websites.
When outlets or legislators do acknowledge the issue of forced sterilizations, they often focus on the abhorrent practice of sterilizing women of color and the subsequent discussions surrounding reparations in states like North Carolina. These women’s stories are undoubtedly important and should be publicized, but the disabled people who also suffered under these policies, and continue to suffer, must not be overlooked, either. With such a wide body of evidence and material for discussion, the only logical conclusion is that the prevailing silence about the issue is a willful one.
Moreover, the refusal to discuss the disability aspect of coerced sterilization, when it comes up at all, leaves out an important point of intersectional organizing. At The Nation, Salamishah Tillet noted, “We are stuck in a hierarchy of traditional reproductive rights activism, which has historically placed abortion as its primary concern, and other issues, like forced sterilization, far below.” This speaks to the core issue behind the lack of engagement with forced sterilization: It, like the right to have and keep children, is an uncomfortable subject for many activists who do not want to feed into conservative anti-choice narratives.
Here, too, the Australian activists’ UN fight can act as an example for those in the reproductive rights movement. Those advocates aren’t just going to bat for their fellow disabled people. Their appeal also includes a discussion of “gender normalization surgeries”—which can affect fertility, too—forced upon intersex children at or around the time of birth. They argue that such surgeries are a violation of human rights, a position supported by many medical and psychiatric groups around the world, including the Intersex Society of North America. (In some cases, the surgeries may be medically indicated.) It’s a baby step for intersectionality, but those activists, unfortunately, fall somewhat into the same trap many in the United States do: Their case does not include a discussion of sterilization of prisoners and other marginalized groups.
This illustrates the importance of intersectional organizing, an issue activists in the United States have often struggled with. Forcible sterilization is certainly one aspect of reproductive rights, but the continued silence on the subject, especially where disabled people are concerned, effectively tolerates the abuse of scores of people in the United States.
It’s critical to engage with the history of forced sterilization in the country, to advocate for reparations on behalf of all victims, and demand protections for vulnerable groups now. Disabled people remain among the most vulnerable, thanks to the aforementioned laws still on the books permitting the sterilization of disabled wards at the request of their guardians, but women of color and low-income people still face pressures and sometimes outright coercion for sterilization. All of those stories must be enfolded in activism and organizing around the issue.
Taking the issue of forced sterilization to Congress, and possibly to the UN, would be a huge victory and show of solidarity for the American reproductive rights community. But that requires first engaging with the full history of sterilization—including coerced sterilization of disabled people, low-income Americans, and transgender people in addition to people of color—and how it continues to act in the modern-day United States.
The post Disabled People Are Still Being Forcibly Sterilized—So Why Isn’t Anyone Talking About It? appeared first on RH Reality Check.
Tennessee state lawmakers wasted no time taking advantage of a new constitutional amendment, passed on Election Day, that allows the state legislature to pass laws restricting abortion rights.
Rep. Rick Womick (R-Rockvale) pre-filed a bill Thursday that would force women seeking to terminate a pregnancy to receive an ultrasound before they have an abortion. HB 2 would mandate the ultrasound take place no more than 72 hours and not less than 24 hours prior to the abortion being performed.
Womick says that the legislation would let a woman “realize that it’s not just a blob of tissue, it’s a life.”
The forced ultrasound proposal is a type of so-called informed consent bills that have been introduced by anti-choice lawmakers around the country in recent years as part of an overarching attack on abortion rights and access.
The bill requires that during the ultrasound the pregnant person be verbally offered the opportunity to view the ultrasound image and receive a printed copy of the image. If they decline to view the image, the person providing the ultrasound must describe the image “including a medical description of the dimensions of the embryo or fetus.”
A copy of the ultrasound image and a written statement signed by both the pregnant person and the person performing the ultrasound must be kept on file for seven years at the facility where the abortion is to be performed.
The bill includes an exception to the requirement for a pregnant person experiencing “medical emergency or spontaneous miscarriage.” A medical emergency is defined by the bill as any circumstance in which a pregnancy must be terminated to prevent death or “irreversible impairment of a major bodily function.”
Jeff Teague, head of Planned Parenthood of Middle and East Tennessee, told the Murfreesboro Daily News Journal that the proposed legislation is not about women’s health and safety, but an attempt to prevent women from obtaining abortion care.
“Women are given that opportunity (to view ultrasound images) now, the only difference is this is forcing women to either view the ultrasound or to have something described to them that they may not want,” Teague said. “This is about shaming women and demeaning them.”
The bill also requires the ultrasound to be performed by a “qualified medical professional trained in sonography and working under the supervision of a physician” who is licensed by the state.
The legislation is modeled after a Texas law, but Womick said his bill is “less invasive” because it requires an external ultrasound instead of an internal ultrasound. However, Womick’s bill does not include an exception to the requirement for victims of rape or incest—unlike the Texas law.
After Amendment 1 was passed, House Speaker Beth Harwell (R-Nashville), who is facing a challenge by Womick for his speakership, promised at least three bills to restrict access to abortion would be introduced and considered during the upcoming legislative session.
Among the expected legislation is a mandatory waiting period and forced counseling requirement and inspection requirements for all facilities that provide abortion services.
If the bill is passed and signed by the governor after the state legislature convenes on January 13, the bill would become law on July 1.
The post Tennessee Lawmaker Introduces First of What Could Be Many Anti-Choice Laws for 2015 appeared first on RH Reality Check.
Anti-choice Missouri legislators are primed to continue their assault on reproductive rights by planning to introduce a bill in January that would require health inspections of abortion clinics. There was, as of January 2014, only one abortion clinic in Missouri, a Planned Parenthood in St. Louis.
A bill was submitted by state Sen. Wayne Wallingford (R-Cape Girardeau) this month that would mandate state health officials to conduct annual inspections of abortion clinics, a requirement that was introduced in similar legislation during the 2014 legislative session.
The bill is scheduled to be introduced at the start of the next General Assembly session, beginning in January, according to local news outlet KOAM.
The similarly worded bill was introduced last winter by state Rep. Kathy Swan, though it was never passed. That legislation would have required the state Department of Health and Senior Services (DHSS) to conduct four inspections of all abortion providers. It would also give the DHSS the power to force the immediate closure of clinics they deem to pose a “serious risk of harm” to patients.
As RH Reality Check has reported, the bill introduced this year was a response to an inspection of the Planned Parenthood clinic in St. Louis in January 2013. Though the DHSS found that the clinic was in “substantial compliance with the rules and regulation for abortion facilities,” anti-choice activists have lauded the inspection as proof of the need to keep a closer eye on clinics in the state, narrowing in on details of the inspection like the amount of dust in the clinic to make specious claims about abortion safety.
GOP state Rep. Stanley Cox during the 2014 session told the St. Louis Post-Dispatch that he thinks “there’s some concern that Missouri is not doing enough to protect life.”
During that legislative session, Missouri lawmakers considered myriad anti-choice bills—at least 30, or more than any other kind of legislation in nearly every other state in the country. Those bills included mandatory waiting periods, increased ultrasound requirements, and parental consent regulations.
The post Missouri Poised to Re-Introduce Abortion Clinic Inspection Bill appeared first on RH Reality Check.
Advocates are urging members of Congress to remember basic funding priorities for women’s health as lawmakers look toward crafting a new budget.
Planned Parenthood Federation of America circulated a memo last week calling on Congress to fund four key women’s health issues, using both an omnibus appropriations bill and the annual defense authorization bill:
—A minimum of $300 million for family planning and cancer screenings for low-income women through the Title X program.
—At least $101 million for comprehensive sex education and teen pregnancy prevention programs, and the defunding of ineffective, frequently inaccurate abstinence-only sex education programs supported by some Republicans who won hotly-contested elections this month.
—Equal access to abortion coverage for Peace Corps volunteers.
—Expanding access to contraception for military service members and their dependents.
The military contraception bill, introduced by Sen. Jeanne Shaheen (D-NH), could become an amendment to the must-pass defense authorization bill, which usually goes through in December.
The other policies depend on how Congress chooses to fund the government in this lame-duck session.
A spending bill of some kind has to be passed by December 11 or the government will shut down. Congress can choose either an omnibus spending bill, which funds the government through next year and can include new programs and funding levels, or a continuing resolution (CR), which is a temporary stop-gap that only continues current funding levels.
Some Congressional Republicans are pushing for a short-term CR, which could allow them to wage a government shutdown war over Obama’s executive action on immigration early next year.
An omnibus bill, on the other hand, could fund new policies like equal abortion coverage for Peace Corps volunteers, currently the only group with federal health insurance that can’t get abortion coverage even in cases of rape, incest, or life endangerment.
That measure passed with bipartisan support out of the appropriations committees in both the House and Senate, but those efforts will be for naught unless an omnibus bill passes.
Also hanging in the balance of how Congress chooses to act is new funding to test a massive backlog of rape kits.
Appropriations committee members are optimistic about passing an omnibus spending bill.
“We’re still working diligently and making progress, and hope to pass an omnibus [bill] through the House by December 11,” Matthew Dennis, spokesperson for the committee’s Democrats, told RH Reality Check.
Funds for family planning and teen pregnancy prevention would continue under a CR, but the funding levels could be much lower than needed. Sequestration has gutted Title X funding in the past several years, and Title X funding in fiscal year 2014 was only about the same as it was in 2005.
The minimum amount Planned Parenthood wants to see appropriated for Title X and teen pregnancy prevention in 2015 are “perfectly appropriate” because they have already been endorsed by the Senate appropriations subcommittee, Dana Singiser, vice president for public policy and government affairs at Planned Parenthood, told RH Reality Check.
“It’s common-sense politics,” Singiser said, noting that the federal government saves $7 for every dollar it spends on family planning.
It’s also good politics, she said, because the midterm elections proved that “being against abortion and birth control is essentially a disqualifier” in competitive races. Despite huge Republican wins in the end, numerous conservative candidates felt the need to downplay or obscure their anti-choice positions on birth control and abortion during the campaign.
Planned Parenthood isn’t pushing for drastic increases in funding for Title X or sex education. It’s about “what we believe is a reasonable number given where the appropriations process is,” Singiser said. But there is always a need for more spending on family planning and public health.
“The federal investment is really modest for what the need is,” she said.
The post Will Congress Budget for Women’s Health in Lame-Duck Session? appeared first on RH Reality Check.
Nina Pillard, as a professor at Georgetown Law School, argued that access to contraception and abortion is an important part of ensuring gender equality. As a litigator, she argued, and won, the critically important cases United States v. Virginia, which opened the Virginia Military Institute to women, and Nevada Department of Human Resources v. Hibbs, which successfully defended the Family and Medical Leave Act against claims it was unconstitutional.
And in Priests For Life v. HHS, she authored the judicial opinion that might just save the contraception benefit in the Affordable Care Act (ACA)—a benefit long fought by religious conservatives opposed to the use of contraception and intent on blocking contraceptive access at every point.
Pillard wrote for a panel of judges that unanimously rejected claims brought by Priests for Life and other religiously affiliated nonprofits that the accommodation process for such nonprofits to avoid complying with the ACA’s contraception benefit burdened their religious rights. Her opinion is 85 pages of the clearest and most detailed defense of the contraceptive coverage requirement since Supreme Court Justice Ruth Bader Ginsburg’s dissent in last summer’s Hobby Lobby case.
The questions before Pillard and her colleagues on the D.C. Circuit Court of Appeals in Priests for Life were exactly those that were left unanswered by the Supreme Court in its decision in Hobby Lobby and its interim order in the Wheaton College case.
In Hobby Lobby, the conservatives on the Roberts Court ruled that the contraception coverage requirement in the ACA violated Hobby Lobby’s religious rights under the Religious Freedom Restoration Act (RFRA). In coming to that conclusion, the conservative justices, and in particular Justice Anthony Kennedy, leaned heavily on the fact that the Obama administration had crafted an accommodation process for some entities but did not make that accommodation available for Hobby Lobby.
While the Hobby Lobby decision was a defeat for the administration and the contraception benefit, the silver lining for reproductive health advocates appeared to be that the conservatives on the Roberts Court at least supported the accommodation, which suggested the core of the benefit would remain intact, even if the Roberts Court had managed to carve out a huge piece of it.
But leave it to the conservatives on the Roberts Court to dash progressives’ hopes as soon as they’ve been raised.
With the ink barely dry on the Hobby Lobby opinion, conservatives erased any evidence of a measured approach to contraception benefit and ruled in Wheaton College—a case challenging the accommodation to the benefit for religiously affiliated nonprofits—that the accommodation itself was also likely a RFRA violation. That called into doubt the legal footing of the entire accommodation process.
If conservatives on the Roberts Court left open the question of whether they would accept the accommodation post-Wheaton College, Pillard’s opinion in Priests for Life presses them for an answer. Specifically, Pillard’s opinion starts with a clear, concise summary of the coverage benefit under the ACA, including the accommodation available to religiously affiliated non-profits.
She details the steps businesses like Priests for Life must take to avail themselves of the accommodation and explains how third parties step in to make sure both the objecting organizations have no obligations to provide contraception coverage once the administration has been notified of their objections, and that access to contraception is seamless for employees and students who need it.
It’s not easy to write clearly about insurance regulations, but Pillard does just that. In the face of a campaign against the contraception benefit that is built on misinformation—both in how the benefit works and in the court’s role in evaluating religious objections to it—the opinion is an almost radical act of jurisprudence.
Pillard and her colleagues do the tough work of judging here, something that feels almost brave compared to the willingness by many lawmakers and judges to simply roll over lest they be accused of persecuting the religious right.
“Accepting the sincerity of Plaintiffs’ beliefs, however, does not relieve this Court of its responsibility to evaluate the substantiality of any burden on Plaintiffs’ religious exercise, and to distinguish Plaintiffs’ duties from obligations imposed, not on them, but on insurers and [third party administrators],” Pillard wrote. “Whether a law substantially burdens religious exercise under RFRA is a question of law for courts to decide, not a question of fact.”
What happens when the court takes the time to actually evaluate the myriad claims by groups like Priests for Life? The claims fall apart.
“Plaintiffs’ opposition to the consequences of the ACA’s Women’s Health Amendment, even with the accommodation, amounts to an objection to the regulations’ requirement that third parties provide to Plaintiffs’ beneficiaries products and services that Plaintiffs believe are sinful,” Pillard wrote. “But RFRA does not grant Plaintiffs a religious veto against plan providers’ compliance with those regulations, nor the right to enlist the government to effectuate such a religious veto against legally required conduct of third parties.”
Pillard laying bare the true nature of the attacks on the accommodation is refreshing. But where Pillard’s opinion matters most is with regard to those open questions left from last summer’s Wheaton College interim order. Here she makes it clear there’s no justifiable reason for the Roberts Court to undermine the accommodation—but just to be sure she offers up an analytical road map with two important markers for Justice Kennedy, the likely swing-vote, to follow.
The first, and perhaps most important marker Pillard leaves for the conservatives on the Roberts Court is the issue of the government’s interest in the contraception benefit. The conservative majority, in its Hobby Lobby opinion, assumed without ruling that the government had asserted a compelling interest in making contraception coverage widely available. In legal terms, that part of the decision is called dicta, which means it was basically just words and has no binding effect in future cases. The Roberts Court didn’t actually rule that the Obama administration has a compelling interest in making contraception coverage widely available, which leaves open the possibility that in a future case they could change their minds.
The Supreme Court majority in Hobby Lobby characterized the government’s interests in “promoting public health and gender equality” as “broadly framed” and noted that RFRA “contemplates a more focused inquiry.”
Pillard’s opinion gives them that more focused inquiry. Noting first that “[t]he government’s asserted compelling interest here, writ large, is in a sustainable system of taxes and subsidies under the ACA to advance public health,” Pillard goes on to provide eight pages of analysis as to what, specifically, is the government’s compelling interest in providing contraception coverage under the ACA; she includes citations to Congressional testimony, public health findings regarding the widespread benefits of available contraception and its susceptibility to even seemingly trivial disruptions, and other federal statutes like the Family and Medical Leave Act and the Pregnancy Discrimination Act.
That is what makes Pillard’s opinion in Priests for Life so important: not just the outcome that will inevitably be appealed, but the road map she drafted—a truth not lost on Obamacare opponents.
“This decision by the D.C. Circuit, a court that was recently packed by Obama through Harry Reid’s nuclear option, totally disregards the meaning of material cooperation as our Church teaches it,” said Robert Muise of the American Freedom Law Center, which represents Priests for Life in this case, in a statement. “No doubt, contraception is a sacrament of the secular left, and this decision, which was authored by one of the recent Obama-appointed judges, is a tribute to it.”
Amid a mixed record on judicial nominations, the fact that the Obama administration fought so hard for Pillard’s appointment stands out as an example of hardline politics by an administration normally plagued by political under-reach.
The importance of Pillard’s appointment has become clear. No other judge could have written that opinion, and at such a critical moment in the fight over the ACA, there is probably no better judge to have done so than Nina Pillard.
The post Has the Affordable Care Act’s Contraception Benefit Been Saved? appeared first on RH Reality Check.
Intravenous drug use has surged in the United States over the last decade. Though media narratives around the uptick tend to focus on crime rates or overdose, the risk of contracting HIV or hepatitis C through used needles is also a major public health concern. And thanks to restrictive laws and limited health-care options, halting the spread of these infections is often a losing battle—one that puts poor women in particularly high danger. Yet Congress still refuses to provide the federal funding that could be key to combating this crisis.
Many intravenous substance users are at heightened risk of contracting HIV or hepatitis C from sex work or sexual violence. According to a 2010 study by the Reference Group to the United Nations on HIV and Injecting Drug Use, between 15 and 66 percent who use injection drugs engage in sex work. Daniel Raymond, the policy director at the Oakland, California-based Harm Reduction Coalition, noted that clients often offer to pay sex workers more for unprotected sex. He also added that in some places, law enforcement can point to condoms as evidence of prostitution, which discourages sex workers from carrying them.
The UN report also stated that women who use intravenous drugs are subjected to higher levels of violence, including sexual abuse. Among other mental, emotional, and physical consequences, these assaults can also lead to sexually transmitted infections.
For poor or homeless women with HIV or hepatitis C, accessing care options at all can be nearly impossible. In some states—California, for example—Medicaid doesn’t cover hepatitis C treatments unless a patient has very advanced liver disease and can prove either six months of substance abstinence or is in a treatment program.
And if those women become pregnant, that can lead to serious ramifications for their children, too. Pregnant women with untreated HIV have a 25 percent chance of passing the virus on to their babies during gestation or delivery. Meanwhile, according to Emalie Huriaux, the director of federal and state affairs at the San Francisco-based advocacy group Project Inform, only about 5 percent of women with hepatitis C transmit the virus to their baby—but infants who do contract it are at risk for developing cirrhosis or liver cancer as adults. This is not to mention the hardships that come from trying to raise an infant as a parent with an expensive, often debilitating disease.
In order to combat this cycle of complications, many grant-funded centers across the country provide free resources that promote healthy living for women, including condoms and other contraceptives, referrals to prenatal care, and lists of people potentially dangerous to sex workers. Many also offer treatment for HIV and hepatitis C; the former can help drive down a pregnant woman’s viral load before birth and protect babies from infection during breastfeeding, and the latter can help women keep from spreading the infection further. Additionally, evidence shows that even when infections are not a factor, prenatal care can reduce the effects of substance use on perinatal outcomes.
Unfortunately, care providers say, drug users are often met with suspicion or even punishment when they need medical care. As a result, they are often hesitant to seek out help when they need reproductive services.
“There’s such a tremendous amount of stigma within the health care system around people who use drugs,” said Whitney O’Neill Englander, government relations manager for the Harm Reduction Coalition. “And women who use who have children or are pregnant have the highest amount. You see it play out in people taking women’s children away from them based on no evidence they’ve harmed them. You hear a lot about people calling child protective services if there are children involved. It’s pretty routine in terms of if a mother says she has used drugs while pregnant.”
This understandable fear of going to the doctor, or being honest about their drug use if they do go, puts mothers’ health—and the well-being of their fetuses, children, and communities—in further jeopardy.
One way to overcome this reluctance among substance users, advocates say, is to combine reproductive health care with needle exchanges, which provide individuals with sterilized syringes in exchange for ones that could be contaminated.
“Needle exchanges are among the only way to get women who are at high risk in the door,” Mary Wheeler, outreach program director at Randolph, Massachusetts-based Healthy Streets, told RH Reality Check. “When you’re using, you need needles on a daily basis. Syringe exchange programs get more people involved in health-care treatment.”
Needle exchange programs, which became popular in the 1980s, have proved to be key in driving down HIV and hepatitis C infection rates; they also offer counseling services to users trying to curb the habit. Unfortunately, the practice has regularly faced controversy from both law enforcement and policy-makers. In many states, the vague wording around exchange legality can leave advocates vulnerable to arrest. The Obama administration lifted a ban on federal funding for exchange programs in 2009; in 2011, Republicans in Congress reinstated it. As of now, there are only 227 reported programs total in the United States.
Many groups around the country, such as Wheeler’s Healthy Streets, use their syringe exchange programs to connect users to other health services like prenatal care. They label themselves as “harm reduction organizations,” meaning that in addition to such referrals, they prioritize giving drug users and sex workers tools to keep them safe, such as clean needles, filters, and antiseptic towelettes. This positions them as a partner in preserving women’s health, advocates say, rather than a foe.
“Syringe exchange programs are vital for these women in order to have an ally who has the mother’s best interest in mind,” said Catherine Paquette, mobile services manager at the Washington, D.C., harm reduction service HIPS.
Harm reduction as an approach is controversial because many legislators and members of the public make the knee-jerk assumption that it signifies approval of drug use. But it’s worth stating clearly that syringe exchange programs are not federally illegal; they just can’t be paid for by federal dollars. Aside from keeping programs from using money they’re already receiving (for HIV testing from the Centers for Disease Control and Prevention, for instance) that limitation also bottlenecks funds that could be coming from state and local sources.
“States are not undertaking syringe programs because they see the federal ban as sort of a scarlet letter,” Michael Collins, policy manager at the Drug Policy Alliance, told RH Reality Check. “When the ban was lifted during the Obama administration’s first two years, we did see an uptick in states’ interest and funding. When we have the ban in place, it’s incredibly counterproductive for states having syringe programs.”
In Massachusetts, for instance, only ten syringe exchange programs can receive funding from the state’s health department, and each needs approval from its respective local government. Wheeler’s organization, Healthy Streets, is limited to running a voucher program that routes clients to pharmacies where they can receive clean needles because the city Randolph doesn’t allow exchange programs.
“I think people are still unwilling to look at substance use as a public health issue,” said Wheeler. “People are scared of folks who inject drugs. The idea in Massachusetts is still pretty strong that if you have a needle exchange in your community, drug use and crime increases, despite all the evidence that that’s not true.”
Meanwhile, in Washington, D.C., Paquette’s organization, HIPS, started its syringe exchange program in 2007 after Congress lifted a rider that kept the district from funding the group. Using money from the D.C. Health Department, the MAC AIDS FUND, and the Syringe Access Fund, the group’s syringe exchange program reaches not only intravenous drug users but also transgender women who use needles to inject hormones. It also provides ancillary supplies that make injecting safer, like cookers and cotton swabs.
Since D.C. first allowed needle exchanges, there’s been an 80 percent drop in HIV rates among drug users. Still, HIPS could do more if the federal funding ban was not in place, like apply for federal grants to expand and enrich syringe exchange programming. Also, employees whose salary is even partially supported by one of the CDC grants that funds HIPS’ HIV prevention services cannot help with the organization’s syringe exchange branch. In practical terms, that means that while certain HIPS workers can administer an HIV test, lead a support group, or hand out condoms to clients, they have to stop what they’re doing and go get a colleague if those same clients want trade dirty needles for clean ones.
“It’s an administrative annoyance,” said HIPS Executive Director Cyndee Clay. “It takes up time and resources that without the federal ban we wouldn’t have to worry about. The CDC is all about high-impact prevention but can’t talk syringe exchanges. It’s just silly.”
It doesn’t look like the ban will be lifted any time soon, particularly now that Congress is wholly under Republican control. Because it needed compromise on a number of controversial issues in order to reach an agreement in final negotiations, Congress passed the 2014 budget as an omnibus appropriations bill. And since the exchange funding ban is packaged alongside the Affordable Care Act and a number of abortion laws in the Departments of Labor, Health and Human Services, and Education appropriations bill, Democrats did not make rescinding it a priority.
Advocates anticipate that rolling back the ban would require a focus on the issue that many Democrats may not be willing to give. Among many Republicans, Collins says, syringe exchange funding is frequently conflated with government support for drug use.
“The nuances of harm reduction and what harm reduction is not are often present in those offices,” said Collins. “There are a number of Republicans in positions of power, mainly Hal Rogers, who want this ban to remain in place, and I think part of it is a belief that states and local authorities can fund this out of their own pocket, and part is this misguided notion that syringe programs encourage heroin use.”
In reality, harm reduction through syringe exchange benefits the general public as well as injection drug users. In August 2013, then Seattle police chief Jim Pugel wrote a well-circulated op-ed calling Washington “healthier and safer” thanks to the state’s exchange programs.
Syringe exchange programs also save taxpayers money because the costs of HIV and hepatitis C prevention are far less than the costs of treatment: A CDC study found the average cost of a prevented HIV infection by way of a syringe exchange program to be between $4,000 and $12,000. The cost to treat a person infected with HIV? $190,000. With the cure for hepatitis C being marketed at $1,000 per pill, or $80,000 total, the cost comparison is similar. This is not to mention the indirect benefits that come from connecting users with preventive care, including reproductive services.
Perhaps the best reason to re-examine the federal ban on needle exchange funding, however, is to remember the death toll caused by the diseases that exchanges help fight. According to AVERT, an international AIDS and HIV charity, 2011 saw more than 20,000 AIDS-related deaths in children and adults in North America; the CDC reports that hepatitis claims the lives of up to 15,000 people in the United States annually. Given what we know about syringe exchange programs, Congress could be doing more to curb these numbers.
“I work for a number of different issues and this is probably the most frustrating because it’s the most common-sense policy,” said Englander. “You save lives, connect people to treatment, have support of law enforcement. It’s really not acceptable that it’s not utilized because of political reasons. We’re breeding a very expensive health problem.”
The post The Ban on Federal Funding for Needle Exchanges Puts Poor Women in Danger appeared first on RH Reality Check.
Federal officials on Thursday recommended a change to the country’s lifetime ban on blood donation for men who have sex with other men (MSM). The recommendation—which says that men should be able to donate blood if they have not had sex with another man within the year—has been hailed by some as progress.
A closer look reveals that the changes maintain the discriminatory and stigmatizing treatment of gay men by focusing on sexual orientation instead of testing history and status.
Men who have sex with other men have been banned by the Food and Drug Administration (FDA) from donating blood since 1983. The ban made some modicum of sense at the time; during the heart of the AIDS epidemic there wasn’t an easy, quick way to test a person’s HIV status, and fear arose that the illness could be spread through donated blood.
But understanding of the illness and the ability to test for it has come a long way in the 30 years since the ban was first put in place. HIV rapid tests, which reveal positive or negative results within half an hour, are commonplace and even available for use at home, for example.
And in recent years, gay rights advocates, the medical community, and, more recently, Congress have called for an end to the ban, saying it is both discriminatory and medically unnecessary.
The Health and Human Services Advisory Committee’s recommendation is essentially a response to this criticism. And though it is certainly a step forward for MSM who want to donate blood, the recommendation still maintains the discrimination of gay men by basing donation policy on sexual orientation instead of testing status.
“This recommendation—although nominally better than the existing policy—falls far short because it continues to stigmatize gay and bisexual men, preventing them from donating life-saving blood based solely on their sexual orientation,” the Human Rights Campaign’s government affairs director David Stacy said in a statement.
“The current policy, adopted in the earliest days of the HIV/AIDS epidemic, and the new recommendation are both simply wrong and can no longer be justified in light of scientific research and updated blood screening technology. It’s far past time for this stigma to end.”
The American Civil Liberties Union echoed Stacy, pointing out that “the proposed one-year deferral will prevent two men who maintain a committed, monogamous relationship from ever donating blood. This proposed policy does not distinguish between high risk and safer sex practices.”
By only taking into account a person’s sexual orientation—instead of their testing history and status—to determine whether they can donate blood, the proposal is only a small step in the right direction, these groups say.
Though the committee’s recommendation is not binding, it will be considered by the FDA in December.
The post Advocates: Federal Recommendations Against Gay Blood Donation Ban Still Discriminate appeared first on RH Reality Check.