In countries
where mosquitoes are spreading the Zika virus, it can be terrifying to be
pregnant. Millions of women in
Latin America and the Caribbean still have an unmet need for family
planning. In several countries
where Zika is active (the Dominican Republic, El Salvador, Haiti, Honduras,
Nicaragua and Suriname) abortion is a crime, often punishable by long term
imprisonment.
Even in
countries where abortion is legal in cases of rape, incest, or threats to the
life or health of the woman, U.S. aid has been blocked by the Helms Amendment. This policy was passed as an amendment to the Foreign
Assistance Act in 1973 as part of a wave of anti-abortion backlash to the Roe
v. Wade Supreme Court decision of the same year. It states that ‘No
foreign assistance funds may be used to pay for the performance of abortion as
a method of family planning or to motivate or coerce any person to practice
abortions.’
Both Secretary Clinton (and Senator
Sanders) have committed to fix Helms after taking the presidential oath of
office. President Obama has failed
to do so thus far. U.S. aid to
family planning could be helpful in many developing countries in Latin America,
Asia and Africa.
According
to Global Planned Parenthood, One
in three women in the world will experience violence in her lifetime, many before the age of 18. In some
countries that figure can be as high as 70%. High rates of violence contribute
to unintended pregnancy, complications in pregnancy, unsafe abortion, and
maternal deaths in parts of the world where health systems remain weak and
women and communities lack access to quality care.
Rates of
gender-based violence are especially high in areas of conflict and crisis, where rape is used as a tool of war, and in
displaced communities such as refugee camps. Young women are particularly vulnerable to both violence and unintended pregnancy, which
forces many of them to give up school or become mothers before they are ready.
Worldwide, there are more than 20 million unsafe abortions every year that lead to millions of injuries and
22,000 deaths.
Here’s some better news: the percentage of pregnancies that are
unintended is falling in the U.S. Data from the US Centers for Disease Control found that the proportion of
pregnancies in the United States that were unintended dropped from 51% of all
pregnancies between 2006 to 2010 to 45% between 2009 and 2013.. Researchers
consider a pregnancy to be unintended if a woman said she never wanted to have
a child or did not want to have a child yet.
Here’s a new trend
in birth control availability: women are now going to special apps on their
phones to ask for the pill or some other hormonal methods without a doctor’s
visit. They are interviewed online
or by video, and the pills are sent by mail. Planned Parenthood has such an app, called Planned
Parenthood Care. The woman has a
video interview with a doctor or nurse-practitioner. The American College of Obstetricians and Gynecologists has
approved of making the pill available over the counter, but is concerned that
women should see a physician at various times for cancer detection of the
cervix and breast and a general health exam. You can read the story of the new birth control apps in the
New York Times – 6/20/16.
Sadja Greenwood, MD, MPH back issues on this blog
