Carolyn Moynihan

New Chile study challenges the ‘safe abortion’ myth

Carolyn Moynihan
By Carolyn Moynihan
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May 8, 2012 (Mercatornet.com) - One of the great scandals of today’s global village is the deaths of hundreds of thousands of mothers each year simply because they are carrying or giving birth to a child. The last reliable estimate, from 2008, indicated nearly 343,000 of these maternal deaths. The scandal lies in the fact that most of them are easily preventible with basic health care, as the West discovered more than a century ago.

The West, as we know from many statements from the World Health Organisation and reproductive health groups, is anxious to reduce this awful statistic, which is an important aim of the Millennium Development Goals. Unfortunately, this altogether worthy goal is entangled with another: the reduction of fertility in the developing countries, by the quickest means possible. This means that, often before other basic medical and social improvements are in place, there must be universal access to birth control technology—not only contraception but abortion.

Abortion, however, must be safe for the woman—that is, provided by medically qualified people or by medically certified means—and to be safe it must be legal. Where it is illegal it will happen anyway but it will be unsafe, and often lethal. States which persist in keeping abortion illegal or severely restricted (and not the agents who are pushing this form of birth control) are thus contributing to the dire maternal mortality statistics. And states which ban abortion after it has been legal are similarly putting women’s lives at risk. That, as they say, is the narrative.

There’s just one problem with the drift of this story: there is no proof that it is true. The only hard evidence that we have on the subject of restrictive abortion laws and maternal mortality rates (MMR) is very new and it points in the opposite direction.

Research from Chile published a few days ago shows that, when therapeutic abortion was banned in 1989 after a long period when it had been legal in that country, there was no increase in maternal mortality. None at all. On the contrary, maternal deaths continued to decline. Chile today has one of the lowest maternal mortality rates in the world (16 per 100,000 live births), outstripping the United States (18) and, within the Americas, second only to Canada (9). Rather than the rogue violator of women’s reproductive health that the UN makes it out to be, Chile is looking this week like a model for countries that really want to save the lives of mothers.

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It’s important to note here what the study, Women’s Education Level, Maternal Health Facilities, Abortion Legislation and Maternal Deaths: A Natural Experiment in Chile from 1957 to 2007, does not claim. It does not say that making abortion illegal caused a decline in maternal deaths. But it shows, importantly, that the 1989 law did not increase mortality. It continued to decline substantially, although other factors were at work in the decline—notably, the education of women and their ability to shape their own reproductive behaviour. (The latter does not mean quite what birth control fundamentalists mean, as we shall see.)

The study, published in the open access online journal PLoS One, is the work of Chilean and American researchers led by Dr Elard Koch, epidemiologist and a professor at the University of Chile and Universidad Católica de la Santísima Concepción (UCSC). The group, who formed the Chilean Maternal Mortality Research Initiative (CMMRI) for the purpose of the study, had access to exceptionally good data: 50 years of official records from Chile’s National Institute of Statistics, 1957 to 2007. These provide the basis of what the authors call a “natural experiment” in fertility and abortion policy.

What these records show is a dramatic decline in MMR from 1965, when abortions were numerous and abortion was the main cause of mortality, through to 1981; a continuing but slower reduction from 1981 to 2003; and a steady state from 2003 to 2007. To explain this pattern the researchers analysed social policies and trends likely to influence maternal mortality. Here are the key ones, especially for the first phase:

* Delivery by skilled birth attendants. For each 1 per cent increase in the number of deliveries performed by skilled attendants there was an estimated decrease of 4.58 maternal deaths per 100,000 live births. Clean water and other sanitary improvements also played a part.

* Access to maternal healthcare services. Nutrition programmes for mother and child, coupled with the distribution of fortified milk at primary care clinics created new opportunities for pregnancy and birth care for both mother and child. This strategy practically eradicated malnutrition, increased birth weight and contributed to the noteworthy reduction in infant mortality observed in Chile, 3.1/1000 live births for infants 28 days to 1 year of age.

* Women’s educational level. This, says Koch, is the most important factor, and the one which increased the effect of all other factors. Educating women enhances a woman’s ability to access existing health care resources and directly leads to a reduction in her risk of dying during pregnancy and childbirth. Data showed that for every additional year of maternal education in Chile there was a corresponding decrease in the MMR of 29.3/100,000 live births.

Boosting female education did something else: it brought down the fertility rate (currently the TFR is 1.87). To return to a point mentioned earlier, the authors point out that “education promotes higher autonomy in women, allowing them to take control of their own fertility” using the method they prefer. Interestingly, a majority of Chilean women do not prefer artificial contraceptives. The authors note:

“Although the primary care system currently provides universal access to a variety of contraceptives methods, actual use of hormonal contraceptives and intrauterine devices in Chile reaches approximately 36% of women of reproductive age. Therefore, as in developed nations, other factors not limited to the use of artificial contraceptives seem to be contributing to the reduction in TFR in Chile. One such factor could be women’s increasing level of education.”

And here the news stops being good. At this point Chilean woman meets North American and European and Antipodean woman in a pattern of delayed motherhood—and pathologies associated with that delay. Koch and colleagues describe this “fertility paradox” as follows:

Although a strong correlation did exist between the decline on the MMR and the reduction on total fertility rate (i.e. the average number of children that would have been born to a woman over her reproductive lifetime), the increase in the number of first pregnancies at advanced ages was directly associated with an increase on maternal deaths. For every 1% increment in primiparous women giving birth older than 30 years of age, an increase of 30 maternal deaths per 100,000 live births was estimated. Thus, when the total fertility decreases and produces a delayed motherhood it can also provoke a deleterious effect on maternal health via an increase of the obstetric risk associated with childbearing at advanced ages.

Before 1980 the causes of MMR in Chile were on the whole directly related to pregnancy and birth. From then on the underlying health problems of “aging pregnancy” began to take over in the mortality stakes: hypertension, diabetes and obesity among others. The problem now, there and here in the developed world, “is not a matter of how many children a mother has, but a matter of when.”

Did the reproductive health brigade get that? Delayed motherhood can be literally deadly. At a certain point, the gains of education and good health and social services are taken too far and recoil upon the modern woman. With the greater part of the world, including many developing countries, now below replacement TFR, maternal mortality from social progress is set to climb before deaths from deprivation have been thoroughly, and one could say properly, addressed.

Koch’s study shows that the custodians of reproductive health profoundly misunderstand the remedy for maternal mortality in developing countries. Will they do any better when they try to come to grips with the fertility paradox?

Carolyn Moynihan is deputy editor of MercatorNet. This article is reprinted under a Creative Commons License.

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Newsbusters Staff

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Disney ABC embraces X-rated anti-Christian bigot Dan Savage in new prime time show

Newsbusters Staff
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March 30, 2015 (NewsBusters.org) -- Media Research Center (MRC) and Family Research Council (FRC) are launching a joint national campaign to educate the public about a Disney ABC sitcom pilot based on the life of bigoted activist Dan Savage. MRC and FRC contacted Ben Sherwood, president of Disney/ABC Television Group, more than two weeks ago urging him to put a stop to this atrocity but received no response. [Read the full letter]

A perusal of Dan Savage’s work reveals a career built on advocating violence — even murder — and spewing hatred against people of faith. Savage has spared no one with whom he disagrees from his vitriolic hate speech. Despite his extremism, vulgarity, and unabashed encouragement of dangerous sexual practices, Disney ABC is moving forward with this show, disgustingly titled “Family of the Year.”

Media Research Center President Brent Bozell reacts:

“Disney ABC’s decision to effectively advance Dan Savage’s calls for violence against conservatives and his extremist attacks against people of faith, particularly evangelicals and Catholics, is appalling and outrageous. If hate speech were a crime, this man would be charged with a felony. Disney ABC giving Dan Savage a platform for his anti-religious bigotry is mind-boggling and their silence is deafening.

“By creating a pilot based on the life of this hatemonger and bringing him on as a producer, Disney ABC is sending a signal that they endorse Dan Savage’s wish that a man be murdered. He has stated, ‘Carl Romanelli should be dragged behind a pickup truck until there’s nothing left but the rope.’ ABC knows this. We told them explicitly.

“If the production of ‘Family of the Year’ is allowed to continue, not just Christians but all people of goodwill can only surmise that the company Walt Disney created is endorsing violence.”

Family Research Council President Tony Perkins reacts:

“Does ABC really want to produce a pilot show based on a vile bully like Dan Savage?  Do Dan Savage’s over-the top-obscenity, intimidation of teenagers and even violent rhetoric reflect the values of Disney?  Partnering with Dan Savage and endorsing his x-rated message will be abandoning the wholesome values that have attracted millions of families to Walt Disney.”

Dan Savage has made numerous comments about conservatives, evangelicals, and Catholics that offend basic standards of decency. They include:

  • Proclaiming that he sometimes thinks about “f****ing the shit out of” Senator Rick Santorum

  • Calling for Christians at a high school conference to “ignore the bull**** in the Bible”

  • Saying that “the only thing that stands between my d*** and Brad Pitt’s mouth is a piece of paper” when expressing his feelings on Pope Benedict’s opposition to gay marriage

  • Promoting marital infidelity

  • Saying “Carl Romanelli should be dragged behind a pickup truck until there’s nothing left but the rope.”

  • Telling Bill Maher that he wished Republicans “were all f***ing dead”

  • Telling Dr. Ben Carson to “suck my d***. Name the time and place and I’ll bring my d*** and a camera crew and you can s*** me off and win the argument.”

Reprinted with permission from Newsbusters

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Jacqueline Harvey

Ending the end-of-life impasse: Texas is poised to ban doctor-imposed death by starvation

Jacqueline Harvey
By Jacqueline Harvey

AUSTIN, Texas, March 30, 2015 (TexasInsider.org)  After five consecutive sessions of bitter battles over end-of-life bills, the Texas Legislature is finally poised to pass the first reform to the Texas Advance Directives Act (TADA) in 12 years. An issue that created uncanny adversaries out of natural allies, and equally odd bedfellows, has finally found common ground in H.B. 3074 by State Rep. Drew Springer.  

H.B. 3074 simply prohibits doctor-imposed euthanasia by starvation and dehydration.

Since H.B. 3074 includes only those provisions and language that all major organizations are on record as having deemed acceptable in previous legislative sessions, there is finally hope of ending the end-of-life impasse in the Texas Capitol.

Many would be surprised to learn that Texas law allows physicians to forcibly remove a feeding tube against the will of the patient and their family. In fact, there is a greater legal penalty for failing to feed or water an animal than for a hospital to deny a human being food and water through a tube.

This is because there is no penalty whatsoever for a healthcare provider who wishes to deny artificially-administered nutrition and hydration (AANH). According to Texas Health and Safety Code, “every living dumb creature” is legally entitled access to suitable food and water.

Denying an animal food and water, like in this January case in San Antonio, is punishable by civil fines up to $10,000 and criminal penalties up to two years in jail per offense. Yet Texas law allows health care providers to forcibly deny food and water from human beings – what they would not be able to legally do to their housecat. And healthcare providers are immune from civil and criminal penalties for denial of food and water to human beings as long as they follow the current statutory process which is sorely lacking in safeguards.

Therefore, while it is surprising that Texas has the only state law that explicitly mentions food and water delivered artificially for the purpose of completely permitting its forced denial (the other six states mention AANH explicitly for the opposite purpose, to limit or prohibit its refusal), it is not at all surprising that the issue of protecting a patient’s right to food and water is perhaps the one point of consensus across all major stakeholders.

H.B. 3074 is the first TADA reform bill to include only this provision that is agreed upon across all major players in previous legislative sessions.

There are irreconcilable ideological differences between two major right-to-life organizations that should supposedly be like-minded: Texas Alliance for Life and Texas Right to Life. Each faction (along with their respective allies) have previously sponsored broad and ambitious bills to either preserve but reform the current law (Texas Alliance for Life’s position) or overturn it altogether as Texas Right to Life aims to do.

Prior to H.B. 3074, bills filed by major advocacy organizations have often included AANH, but also a host of other provisions that were so contentious and unacceptable to other organizations that each bill ultimately died, and this mutually-agreed-upon and vital reform always died along with it.

2011 & 2013 Legislative Sessions present prime example

This 2011 media report shows the clear consensus on need for legislation to simply address the need to protect patients’ rights to food and water:

“Hughes [bill sponsor for Texas Right to Life] has widespread support for one of his bill’s goals: making food and water a necessary part of treatment and not something that can be discontinued, unless providing it would harm the patient.”

Nonetheless, in 2013, both organizations and their allies filed complicated, contentious opposing bills, both of which would have protected a patient’s right to food and water but each bill also included provisions the rival group saw as contrary to their goals. Both bills were ultimately defeated and neither group was able to achieve protections for patients at risk of forced starvation and dehydration – a mutual goal that could have been met through a third, narrow bill like H.B. 3074.

H.B. 3074 finally focuses on what unites the organizations involved rather than what divides them, since these differences have resulted in a 12 year standoff with no progress whatsoever.

H.B. 3074 is progress that is pre-negotiated and pre-approved.

It is not a fertile springboard for negotiations on an area of mutual agreement. Rather it is the culmination of years of previous negotiations on bills that all came too late, either due to the complexnature of rival bills, the controversy involved, or even both.

On the contrary, H.B. 3074 is not just simply an area of agreement; moreover, it is has already been negotiated. It should not be stymied by disagreements on language, since Texas Alliance for Life and Texas Right to Life (along with their allies) were able to agree on language in 2007 with C.S.S.B. 439. C.S.S.B. 439 reads that, unlike the status quo that places no legal conditions on when food and water may be withdrawn, it would be permitted for those in a terminal condition if,

“reasonable medical evidence indicates the provision of artificial nutrition and hydration may hasten the patient’s death or seriously exacerbate other major medical problems and the risk of serious medical pain or discomfort that cannot be alleviated based on reasonable medical judgment outweighs the benefit of continued artificial nutrition and hydration.”

This language is strikingly similar to H.B. 3074 which states, “except that artificially administered nutrition and hydration must be provided unless, based on reasonable medical judgment, providingartificially administered nutrition and hydration would:

  1. Hasten the patient’s death;
  2. Seriously exacerbate other major medical problems not outweighed by the benefit of the provision of the treatment;
  3. Result in substantial irremediable physical pain, suffering, or discomfort not outweighed by the benefit of the provision of the treatment;
  4. Be medically ineffective; or
  5. Be contrary to the patient’s clearly stated desire not to receive artificially administered nutrition or hydration.”

With minimal exceptions (the explicit mention of the word terminal, the issue of medical effectiveness and the patient’s right to refuse), the language is virtually identical, and in 2007 Texas Right to Life affirmed this language as clarifying that “ANH can only be withdrawn if the risk of providing ANH is greater than the benefit of continuing it.”

Texas Right to Life would support the language in H.B. 3074 that already has Texas Alliance for Life’s endorsement. Any reconciliation on the minor differences in language would therefore be minimal and could be made by either side, but ultimately, both sides and their allies would gain a huge victory – the first victory in 12 years on this vital issue.

It seems that the Texas Advance Directive Act, even among its sympathizers, has something for everyone to oppose.

The passage of H.B. 3074 and the legal restoration of rights to feeding tubes for Texas patients will not begin to satisfy critics of the Texas Advance Directives Act who desire much greater changes to the law and will assuredly continue to pursue them. H.B. 3074 in no way marks the end for healthcare reform, but perhaps a shift from the belief that anything short of sweeping changes is an endorsement of the status quo.

Rather, we can look at H.B. 3074 as breaking a barrier and indicating larger changes are possible.

And if nothing else, by passing H.B. 3074 introduced by State Rep. Drew Springer, we afford human beings in Texas the same legal access to food and water that we give to our horses. What is cruel to do to an animal remains legal to do to humans in Texas if organizations continue to insist on the whole of their agenda rather than agreeing to smaller bills like H.B. 3074.

The question is, can twelve years of bad blood and bickering be set aside for even this most noble of causes?

Reprinted from TexasInsider.org with the author's permission. 

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But though we have made great strides in the past few days, we still need many more donations if we are going to have any hope of making it all the way by April 1st.

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