Zika, Family Planning, & the Helms Amendment

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