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Q. and A.: How Trump’s Revival of an Abortion Ban Will Affect Women in Kenya - The New York Times

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Q. and A.: How Trump’s Revival of an Abortion Ban Will Affect Women in Kenya - The New York Times

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This week President Trump revived a ban on providing foreign aid to health providers abroad that offer abortion counseling as part of their family planning services. Caitlin Parks, a family planning fellow at Washington University in St. Louis, provides reproductive health services to women at clinics and a teaching hospital in western Kenya. Her clinics receive American funding, and she says that the ban, called by critics the global gag rule, could have a major impact on poor women and communities like the ones she serves.

This Q. and A., which is based on an online response and phone interview, has been edited and condensed.

What type of women do you serve in western Kenya?

Mostly impoverished, many with H.I.V. or other medical conditions that make pregnancy complicated or risky.

Many of the women rely on agriculture and small plots of land for both their food and their income. This is an area that has a high rate of H.I.V. and has for many years, and so there is quite a large population of H.I.V. positive women and families that have been greatly affected by H.I.V. There is a high rate of orphans and a need for extended family for support.

There are lots of women as the primary supporters of their children and their extended family.

What is their biggest maternal health need?

Their biggest need is full-spectrum reproductive health care, including contraceptive and sometimes abortion services, as well as full maternity care.

One of the things that is a challenge in the system of reproductive health care is that for many people they don't necessarily know that they need it until they are faced with an unplanned pregnancy. One of the biggest killers in sub-Saharan Africa is maternal mortality, and lots of these people don't necessarily know that they need to protect themselves from that. So they aren't necessarily seeking out contraceptive care until it's too late - they have an unplanned pregnancy that might affect their life.

Both to have healthy lives and economically to be able to support their families, limiting and spacing pregnancies is incredibly important.

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A group gathered for counseling on family planning options in western Kenya.

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Caitlin Parks outside the United States Supreme Court in October 2016. She spent a week in Washington lobbying with Physicians for Reproductive Health.

Why might these pregnancies lead to a maternal death?

The major reason is lack of access to care. Here in the U.S., we take being pregnant as being much safer. In the U.S., we have a clinic and easy access to a facility if a woman needs it. There are no ambulances in large swaths of the area that we serve, so if someone does have a complication from a pregnancy they die much easier than in the U.S.

The same goes for abortion. We know, regardless of whether we agree or disagree with it, that they will occur. Here in the U.S., because it is legal and we have better access, we know that we can obtain a safe abortion. There, for women who do have an abortion, it is much more likely to be unsafe and lead to both health- and life-threatening conditions.

And we know certainly that the only way to prevent life- and health-threatening conditions from a pregnancy or an abortion is to make contraception available to all women.

How will the ban affect your clinics and the services you provide?

Abortion is illegal in Kenya. The biggest thing for us is the fact that there are certain conditions within Kenyan law that allow it to be performed - both health and life conditions. But the U.S. ban is not clear. Sometimes, there is an interpretation that we could refer for an abortion, if they are in a health-threatening condition. The other interpretation is only if life threatening. That difference between health and life threatening is problematic. It scares providers from talking about it at all, even in cases when it could be both health and life threatening.

For other institutions, in countries where abortion is legally available, it prevents them from performing or referring for abortion services.

No matter where you are in the world, the most important thing is to be able to make these decisions with a woman and her doctors as to what they think is the most important and safest thing for a woman and her body, and not to be guided by blanket rules that are not guided by patient care.

When we have something, like the global gag rule, it doesn't allow for some of the nuances that are important for making those individual decisions. Even if it would be allowed, no one will even discuss the possibilities because the entire topic is silenced.

Describe a patient who needed your services.

She was a young woman with a dangerous heart condition that requires medication that would pose risks to a developing fetus. She thought that she could not become pregnant because of her condition and had previously been unable to afford birth control. When she became pregnant, she was afraid of becoming sicker and dying, leaving her young children orphaned. She needed access for a safe, legal abortion.

We were able to provide her a referral for a safe abortion within our own organization.

This ban would mean that we would not even be able to give her information about where to go, leaving her to find some other unsafe means of obtaining her needed health care.

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Q. and A.: How Trump's Revival of an Abortion Ban Will Affect Women in Kenya

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This week President Trump revived a ban on providing foreign aid to health providers abroad that offer abortion counseling as part of their family planning services. Caitlin Parks, a family planning fellow at Washington University in St. Louis, provides reproductive health services to women at clinics and a teaching hospital in western Kenya.

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Letters: Abortion bill would intrude on patients' privacy

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Letters: Abortion bill would intrude on patients' privacy

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On Wednesday, the Indiana General Assembly will hold hearings for Senate Bill 340, a bill touted as "protecting" Hoosier women, but in reality it is a dangerous intrusion into the sacred patient-provider relationship that is so important to me as an obstetrician-gynecologist.

This bill requires that any doctor, clinic or hospital report to the state if they believe a woman's condition may be due to her having had an abortion. The conditions they list include endometriosis and preterm labor, which affect many women, regardless of whether or not they have had an abortion. The doctor, clinic or hospital is then required to report an extensive amount of private information, including how she paid for her medical procedure. Failing to report this could draw criminal prosecution. There is no other medical procedure that requires anywhere near this much investigation, despite the fact that abortion is one of the safest medical procedures, safer even than colonoscopies.

This invasive requirement will undoubtedly lead to intrusive questioning of women about their private medical decisions when they are being treated for unrelated medical conditions. The result is making women feel shame for conditions that they do not have control over and did not cause. This will hurt the patient-provider relationship and cause a breach of trust so deep that patients might stop seeking medical care.

The bill also includes requirements to report even the suspicion that a woman may have received a medication that could cause an abortion from a website or by mail order. Inserting this sort of suspicion into the patient-provider relationship is dangerous and alarming. This is clearly for the purpose of vilifying, prosecuting and jailing women who, due to desperate conditions, may feel they have no other option but to end their pregnancy by these means. Indiana has done this before.

Is this the type of state government we Hoosiers want? One who intrudes into our exam rooms, our private medical decision-making, and our private medical conditions? One who prosecutes and jails women who are most in need of our help and support?

This bill will not improve the health of even one woman in Indiana. This bill will only create a government surveillance system that will hurt women and hurt the sacred patient-provider relationship I value so much with my own patients.

Please join me to speak up and voice your support for the privacy of Hoosier women and against SB340.
Dr. Caitlin Bernard Physicians for Reproductive Health Israel persecutes Palestinian Christians
In response to Gary Varval's Jan. 18 column, Varvel points out an important trend of crimes against Christians in the Middle East. However, he implies the Christians in Palestine suffer from the same perpetrators as the Christians in Egypt, Jordan and Syria.

While in Israel and Palestine in May, I visited with the United Nations Office for the Coordination of Humanitarian Affairs in Jerusalem, a dozen Christian Peace organizations and churches, and the Defense for Children International.

Palestinian Christians suffer horrible crimes but not at the hands of other Palestinians or ISIS but all Palestinians suffer at the hands of Israelis in the Israeli settlements in the occupied territories. I learned that the Palestinians are under the authority of the Israeli Army, but the settlers are not. Therefore, settlers who commit crimes against Palestinians (Christians or not) are seldom arrested or prosecuted.

Varvel's column didn't make that distinction; yet I feel that is important because the problem can't be fixed if the cause is not known.
Charlie McDonald President, Christians for Peace and Justice in the Middle East Factors that drive sexual abuse are deeply rooted
I applaud the "#MeToo" movement, and the resulting justice. But unfortunately, the sexual abuse is to wide spread, and most victims do not have the opportunity or ability to resist or report the abuse.

So how do we reduce abuse in the future. First, we must acknowledge that males are sexual opportunists. Numerous individual, familial, cultural and societal influences may lead to males developing into sexual predators. The more power a man wields (position, fame, money, good looks) the greater the temptation to intimidate or force a subordinate for sexual favors.

Parents, schools and religious organizations must teach and reinforce morals and respecting others. But nurturing a value system for our children is not enough.

We must safe guard against societal and cultural influences that model and encourage sexual misconduct. The entertainment industry teaches that sexually aggressive males will be rewarded with sex, and the resistant female wants to be conquered. This message can lead to deprived behavior and sexual coercion, impacting the work place and social situations, including date rape.

The media also belittles morals. For example, talk show hosts ridicule Vice President Mike Pence over his practice of not being alone with a woman other than his wife. So if a man seeks to eliminate opportunity for bad judgment and behavior he is wrong.

This crisis may be compared to the opiate epidemic. Prosecution alone cannot fix the problem. The solution has to be multifaceted with many parties coming together for a long-term solution.
Wendell Howard Noblesville Hate crime law in unnecessary
This letter is in response to Kevin Betz 's op-ed, "State's civil rights laws are weak, outdated".

I must say that I fully expected to disagree with Betz but found myself agreeing with several points while strongly disagreeing with some as well.

As to allowing for a jury trial in a civil rights case, I agree

I might even agree to his point of "emotional distress damages"; I would go along as long as there are reasonable caps. This is just a sop, for the most part, to trial lawyers who take at least 40% of the money. So, perhaps Betz would allow my amendment to this provision by prohibiting any lawyer fees for this set of damages. We'll see how aggressively the attorneys fight this.

I am agnostic on "punitive damages" but might go along if legislation can be crafted that rightly punishes the most grievous cases and eliminates any lawyer fees on this category.

One point Betz makes is that Indiana law that bars "seeking publicity about an administrative hearing involving racism or sexism". He states that this provision is "unconstitutional." If it is, then the law is moot and un-enforceable. No law, in contravention of the state or national constitutions, has effect.

One thing I vehemently oppose is special treatment for groups of citizens. We are or are supposed to be "equal under the law." We don't need more laws. Our Constitution and federal law from the 1960' on have done a great deal to lessen the impact of unfair discrimination. We don't need more laws or more carve-outs for "special people or special groups." Also, crimes are crimes and labeling something with the term "hate" is silly! If I murder you, you aren't more dead because I "hated" you. By the way, how do you even judge that? Giving judges wide discretion on the sentencing side should be sufficient to make sure the most heinous crimes in a given category are properly applied the correct punishment.

If prosecutors aren't doing their job, the citizens can throw them out.
John L. Sorg McCordsville
Read or Share this story: http://indy.st/2EWbVYv

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Letters: Abortion bill would intrude on patients' privacy

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On Wednesday, the Indiana General Assembly will hold hearings for Senate Bill 340, a bill touted as "protecting" Hoosier women, but in reality it is a dangerous intrusion into the sacred patient-provider relationship that is so important to me as an obstetrician-gynecologist.

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April is National Get Yourself Tested Month | Planned Parenthood Advocates of Indiana and Kentucky, Inc.

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April is National Get Yourself Tested Month | Planned Parenthood Advocates of Indiana and Kentucky, Inc.

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As April approaches, and National Get Yourself Tested Month comes along with it, it's the perfect time to talk about sexually transmitted infections - also known as STIs. Right now, Americans are experiencing the highest STI rates ever recorded, so it's a good time to learn why and how to protect yourself.

In 2016, the CDC reported 1.59 million cases of chlamydia, 468,514 cases of gonorrhea, and 27,814 cases of syphilis-an increase of 5 percent, 19 percent, and 18 percent, respectively, from 2015, and the highest number of STI cases ever reported in the United States. Almost two-thirds of all chlamydia and gonorrhea cases occur in people 15-24 years old.

And yet, research in recent years has shown that adolescents today are engaging in sexual intercourse less often - and more safely - than in previous generations. So, what is causing this recent STI epidemic? Research suggests that the answer is the stigma and shame that surround STIs and STI testing.

A 2015 study showed that both men and women 15-24 years old were less likely to seek STI testing due to STI-related stigma, defined as "personal fears about negative societal attitudes toward STIs." The researchers concluded that STI-related stigma is an "important barrier to STI screening for adolescents and young adults."

A similar study from 2014 surveyed low income African-American men and found that STI-related stigma was significantly associated with a lower chance of receiving STI testing. Furthermore, the study found that STI stigma is a significant barrier to an STI-positive person notifying their partner of an STI - preventing them from getting tested and treated.

These infections are easily treated, but if treatment is delayed, they can cause both short- and long-term health problems, including infertility, chronic pain, and more. When someone with an STI doesn't get tested and treated promptly, they are more likely to pass it on to their partner or even multiple partners over long periods of time.

When health care is stigmatized, we often see bad outcomes - stigmatizing abortion leads to barriers to accessing care, stigmatizing sexual orientation leads to harassment and poor health care for LGBTQ+ individuals, and stigmatizing STIs prevents people from getting testing and treatment, therefore increasing the risk of long-term problems and spreading infections to others.

As if stigma from the community isn't bad enough, the current administration has cut essential funds to organizations that treat and research HIV and other STIs and implemented abstinence-only sex education programs that have been proven to have no effect on quelling the spread of STIs. When we don't talk about sex, how can we possibly learn how to prevent STIs?

STIs are severely misunderstood, and learning accurate information is the first step toward ending the stigma. STIs are just like any other infection but are passed from one person to another not by sneezing or coughing, but by sexual contact, including oral, vaginal, or anal sex. An important difference is that many STIs do not cause symptoms, so you may not know you have one. That's why doctors recommend preventing infection in the first place with the use of condoms and regular testing at Planned Parenthood or other STI testing centers. Once you are diagnosed, STIs are easily treated, especially if caught early. Also, just like other infections, early treatment can prevent the spread to others.

Talking about STIs openly and honestly can eliminate the shame, fear, and stigma. The first step is talking about the risks of unsafe sex, how to protect yourself and your partner by using protection correctly every single time, and where to get tested and treated.

We must continue to advocate for programs that provide honest education about sex and sexuality and support everyone in the community receiving non-judgmental healthcare, including STI testing and treatment. Luckily, we have places like Planned Parenthood that continue to provide this care, no matter what.

It's important to get tested regularly for STIs to protect yourself and your partner. STI testing isn't scary - it's quick, painless, and the results will be ready in just a few short days. Your STI results are confidential, and treatment is simple.

This month is National Get Yourself Tested Month, and you can receive free STI testing at Planned Parenthood health centers across Indiana and Kentucky from April 23-28. You can walk-in to your nearest health center for your STI testing, or you can schedule an appointment online to reserve your spot.

There's no better time to take control of your health care and end the stigma than right now!

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April is National Get Yourself Tested Month

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As April approaches, and National Get Yourself Tested Month comes along with it, it's the perfect time to talk about sexually transmitted infections - also known as STIs. Right now, Americans are experiencing the highest STI rates ever recorded, so it's a good time to learn why and how to protect yourself.

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Trump's New Abortion Restrictions Will Affect $9 Billion In US Global Health Money

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Trump's New Abortion Restrictions Will Affect $9 Billion In US Global Health Money

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The Trump administration today released new anti-abortion rules - including a policy name change - that will apply to almost $9 billion in global health funding, including a massive HIV/AIDS prevention program, the State Department announced on Monday.

The rules - dubbed the "Protecting Life in Global Health Assistance" plan, and approved by Secretary of State Rex Tillerson - restrict any foreign nongovernmental organization receiving US global health aid from using any of their other funding to "perform or actively promote abortions as a method of family planning," according to a senior administration official who briefed the press on the plan.

"Referrals for the termination of a pregnancy in cases of rape, incest, or endangerment of the life of the woman are not prohibited under this policy," the official added.

The Tillerson plan is a dramatic expansion of the Mexico City Policy, a Reagan-era restriction that's since been suspended by every Democrat in the White House and revived by every Republican. President Donald Trump signed a memo bringing back the restrictions on Jan. 23.

This expanded policy newly affects several agencies, including the Department of Defense, and programs like the President's Malaria Initiative and PEPFAR, short for the President's Emergency Plan for AIDS Relief. Both programs were started by George W. Bush.

PEPFAR accounts for $6 billion of the $8.8 billion in funds affected by the new policy, according to the administration official.

Humanitarian and disaster relief funding at USAID, the State Department, and the Department of Defense are exempted, officials said, as are State Department funds for migration and refugee assistance.

National and local governments and multilateral institutions, like the Global Fund, are also exempted.

The announcement left unclear when exactly foreign organizations will feel the effects of the policy but promised "a thorough and comprehensive review," focusing especially on newly affected programs, within six months.

Critics say the expansion is more about ideology than about global health.

"The big concern that people have about US taxpayer money funding abortions is in and of itself such a fallacy that it's really hard to understand why they feel the need to go so much further than addressing that specific issue," said Dr. Caitlin Bernard, a fellow with Physicians for Reproductive Health and at the Department of Obstetrics and Gynecology at Washington University in St. Louis.

"The laws already existing have already made that impossible," she said, referring to the 1973 Helms Amendment, which prohibits US funding for abortions overseas.

"You can only surmise that they're trying to do this because of an ideological standpoint," Bernard said.

Jonathan Rucks, advocacy director at PAI, a reproductive health organization in Washington, DC, was more direct. "This is so political. It's red meat to their base; it's not one iota about protecting anyone's life," he said.

Reproductive health experts point out that abortions actually increased the last time Mexico City restrictions were in place. A 20-country study by the Stanford University School of Medicine, published by the World Health Organization in 2011, found that abortion rates actually went up 40% during the last iteration of the policy. In countries most heavily affected by the rule, contraceptive use dropped, and a woman's odds of having an unsafe abortion were more than two times higher.

It's as yet unclear whether the policy's expansion will amplify those outcomes. Administration officials say they'll be monitoring both implementation and outcomes.

But Serra Sippel, president of the Center for Health and Gender Equity in Washington, DC, said post-facto monitoring isn't enough.

"There's no indication that the Trump administration has conducted any
assessment of the impact of this expansion," said Sippel. "It has nothing to do with evidence. It has nothing to do with global health."

The policy guidance comes down a day after Trump issued a statement for Women's Health Week, "recogniz[ing] the importance of providing women access to the best, evidence-based health information and care."

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Trump's New Abortion Restrictions Will Affect $9 Billion In US Global Health Money

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The Trump administration today released new anti-abortion rules - including a policy name change - that will apply to almost $9 billion in global health funding, including a massive HIV/AIDS prevention program, the State Department announced on Monday.