Archive for April, 2010

29 de Abril: Ojo–la ley no te protegerá

Posted in abortion, Bolivia, sexual violence with tags , , , , , , , , , on April 29, 2010 by eugeniadealtura

A couple of recent events have revealed the fragility of women’s right to choose in Latin America and in the United States, despite laws guaranteeing abortion access in those countries (or at least, under certain circumstances).

A few weeks ago, in a piece for Womanist Musings, I commented on the case of a nine-year-old-girl in Brazil who, after much difficulty, succeeded in securing a legal abortion when a rape left her pregnant with twins.  In that case, the Brazilian Archbishop ex-communicated the entire medical team that performed the procedure, along with the girl’s mother.  Now, RH Reality Check brings us the story of another young girl, raped and impregnated by her step-father in Quintana Roo, Mexico.  According to the local reproductive rights group, GIRE (Grupo de Información en Reproducción Elegida), the pregnant girl and her mother “received biased information from authorities about their rights and access to abortion.”

As in Bolivia and in many other areas of Latin America, women in Mexico who become pregnant as a result of rape are legally permitted to have an abortion.  However, in practice, the bureaucratic processes necessary to secure a legal abortion, as well as the tendency of anti-abortion authorities to pressure women against the procedure, make cases of legal abortion fairly rare.  This is not, as many have pointed out, because rape is rare: Marcy Bloom, of GIRE, notes that in 2009 alone, 881 women in the Mexican state of Quintana Roo “became pregnant as a result of rape.”

After some deliberation, this young Mexican girl and her family have decided to continue the pregnancy and keep the child.  Still, anti-choice activists in the country have used the case as an opportunity to attack pro-choice groups like GIRE, arguing that the organization attempted to pressure the girl to get an abortion.  In fact, women who become pregnant as a result of rape in Mexico are much more likely to be pressured by anti-choice elements to give up their legal right to abortion (see the RH article for a number of examples).

In case you are tempted to believe that legal abortion is so difficult to secure in Latin America because of the restrictions surrounding the procedure, think again: this week, abortion access suffered a major blow in the U.S. state of Oklahoma, where Roe v. Wade ostensibly extended abortion rights to women over 30 years ago.  Thanks to the Oklahoma Legislature, women seeking abortion in that state will now have to view ultrasound images and “listen to a detailed description of the fetus.”  Like the 24-hour wait law and other obstacles to abortion access, the Oklahoma measures display the profoundly condescending notion that unless forced, women will not think deeply about their decisions to have an abortion.  That, unless the state imposes its own definitions of “thoughtfulness” and “consideration” onto women’s abortion decisions, then women will approach these decisions with frivolity and disdain.

The photographs in today’s posting were provided by a guest photographer.

When women were granted the vote, we were supposedly recognized by the state as “adults” capable of making independent decisions and of running for office.  Restrictions to abortion access, however, return women to the realm of childhood, where we are deemed wards of the state who cannot be trusted with decisions impacting our own bodies and reproductive lives.  These three stories reveal a painful truth–that we cannot trust the law.  Laws alone will not protect us.  Access to legal abortion–and “permission” to act as capable adults–are still a long way off.

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26 de Abril: Un asunto de conciencia

Posted in abortion, maternal mortality, Uncategorized with tags , , , , , , on April 26, 2010 by eugeniadealtura

Last week, The Lancet published an online study on worldwide maternal mortality that showed significant improvements in maternal death rates since 1980.  Although it continues to sport the highest maternal mortality rate in Latin America, Bolivia emerged of the few countries that is demonstrating “accelerated progress” in this area.  The full article may be accessed here:

The Lancet — Worldwide Maternal Mortality

According to the study, the major factors that have contributed to reducing maternal mortality rates in the last 30 years include dropping total fertility rates, increased income and educational levels among women, and an increase in skilled birth attendants.

Although it is somewhat difficult to measure, I would imagine that in the Bolivian case another factor has contributed to reducing maternal mortality: the Ministry of Health’s program for the treatment of hemorrhages in the first half of pregnancy. Facing high rates of maternal death in part due to complications from abortion, in 1998 the Ministry instituted a program to deal with the public health implications of illegal abortion without touching the legal issue of abortion itself.  The program trains medical providers in the use of the cheap, effective, and safe manual vacuum aspirator (MVA) technology for the solution of incomplete abortion and miscarriage, and in extending non-judgmental care to women who may have attempted to provoke their own miscarriages.

Under the current provisions of the program, a woman experiencing vaginal bleeding in the first twenty weeks of her pregnancy can visit any public health facility to receive an MVA treatment for free under the Seguro Universal Materno Infantil (the universal maternal-child health insurance).  Unlike in the early 1990s–when doctors would sometimes refuse women treatment until they provided the name of the person who had provoked their abortion–medical providers are now prohibited from questioning women about the circumstances of their bleeding. Prior to the introduction of this program, women experiencing bleeding in pregnancy were often too scared to go to a hospital for treatment, which often led to severe infection and even death. Although it is difficult to measure with precision the effects of the hemorrhage treatment program, the Ministry of Health believes that it has greatly reduced maternal deaths due to abortion.

“What a shame that Santa does not give people a conscience…”

Although legalizing abortion and regulating the facilities that provide it is likely the most effective (and most just) means of reducing abortion-related death, the Ministry’s hemorrhage treatment program is perhaps a good stepping stone toward that end.  With the program for the treatment of hemorrhages in the first half of pregnancy, the Ministry is recognizing and elevating the public health aspects of abortion over questions of politics and the supposed protection of (fetal) “life.” Thanks to the dedicated work of individuals of conscience, this program provides an opportunity to keep Bolivia on the right track toward the reduction of maternal deaths.  Hopefully, the next step will be the provision of legal and safe abortion to any woman who decides that she needs it.

17 de Abril: ¿Por qué no, “algo porque sí”?

Posted in Bolivia, health care with tags , , , , , , , on April 17, 2010 by eugeniadealtura

This week, the La Paz daily La Prensa reported on four initiatives being undertaken in city of El Alto to combat tuberculosis (TB).  Luisa Mendizábal, the coordinator of the program, notes that El Alto saw 700 confirmed cases of TB in 2009.  One of the initiatives being used to combat the disease, however, has little to do with TB itself–instead, it uses pregnant women as, essentially, bounty hunters for potentially infected individuals.  The program is tellingly titled “Algo por Algo,” or “something for something”–as in, do something for us, and we’ll do something for you.

It works like this: if a pregnant woman brings an individual with symptoms of TB to her prenatal checkup, then she will not have to wait in line with the dozens of other expectant mothers to be seen.  Instead, she’ll pass directly through the double doors to see the doctor.  It bears mentioning that these women are forced to wait in line for hours because of their participation in another government program: the Bono Juana Azurduy.  As I have previously reported, the Bono Juana Azurduy pays pregnant women to go to state-run medical facilities for prenatal care and for the birth, rather than having their children at home.  While poverty has led expectant mothers to queue for hours to receive a bit of cash and what is often described as a cursory checkup, now Algo por Algo offers women the opportunity to cut down on their wait time by dragging a phlegmy, coughing, potentially TB-infected individual along with them.  Although TB is known to be contagious and potentially fatal, proponents of Algo por Algo are putting pregnant women at risk by giving them incentives to be in close proximity with infected individuals.

In part, I understand the impulse for programs like the Bono Juana Azurduy and Algo por Algo. Many women report being scared of health facilities, either because of their unfamiliarity, or because of the mistreatment that many have experienced there.  In the face of this fear, women often choose to have their children at home, where they are more likely to be attended in the birth by family members or by no one than by a midwife, whose services cost money.  The government officials who created the Bono probably genuinely hoped to reduce maternal deaths by getting women to the hospital.  (They also likely hoped to reduce the practice of traditional medicine and birthing methods.)  But programs like these are inherently flawed, for a number of reasons: they do not address the mistreatment that consistently drives women away from medical facilities, and they may expose pregnant women to TB, for example.

There’s another problem with incentive-based health programs, however, that I find much more fundamental: quality health care should NOT be something you get in exchange for something else.  Health care should be, and in some countries is, a basic human right.  A universal right. When reductions in maternal mortality or TB rates are achieved through cajoling and manipulation, rather than empowerment and education, I am uneasy to call this a true “win.” Rather than “something for something,” health care should be a question of “something just because.

16 de Abril: Una noticia emocionante

Posted in blogging, womanism with tags , , , , , on April 16, 2010 by eugeniadealtura

I’d like to share some exciting news: starting today, I will be occasionally posting over at Womanist Musings.  Womanist Musings is an excellent, progressive, and prolific blog that I have been following for some time.  I’m hesitant to place too many labels upon the blog myself, but this post does a great job of explaining some of the differences between “womanism” and “feminism;” it also includes a link where readers can learn more about the former.  Although regular readers are likely aware that I do consider myself a feminist, I have learned an incredible amount from Womanist Musings and believe that womanism has a great deal to teach anyone interested in women’s rights.

Posts at Womanist Musings digest current events and writers’ personal experiences from a woman-centered perspective.  The site also features an open guest-posting policy, where other bloggers, journalists, activists, etc. often weigh in on a variety of issues.  Needless to say, I am honored to be featured as a guest columnist at this site.  I expect to be posting pieces on Latin American women’s political and sexual and reproductive rights at Womanist Musings once every two weeks, most likely on Fridays.  I strongly encourage you all to hop over to view not only my posts, but those of all the other talented writers featured at Womanist Musings–you won’t be disappointed.

El Puente de la Mujer, Buenos Aires, Argentina.

10 de Abril: Pedacitos

Posted in Bolivia, sexuality, violence against women with tags , , , , , , , on April 10, 2010 by eugeniadealtura

This week, some odds and ends from the Bolivian highlands that I hope will spark conversation and debate.

First, yet another Bolivian woman has been killed in Spain. The 34-year-old migrant, known only by the initials M.S.P., was discovered last week in a Marbella hotel room; she had been suffocated to death.  This week, Spanish police found the likely culprit–her one-time boyfriend, a 39-year-old Peruvian man.  As if to chide the dead woman, this article from Madrid’s El País newspaper notes that M.S.P. “had never reported any mistreatment [that she had received], nor solicited assistance from the Municipality of Málaga nor the Andaluz Institute of Women” (all translations mine).

“Cycle of violence” graphic at a local organization working to combat violence against women.

Several weeks ago, in the aftermath of the murder of another Bolivian woman in Spain, I wrote a post on the problem of domestic violence against migrant women and the particular vulnerabilities these women face because of their status as (often illegal) migrants.  Even women living in their countries of birth hesitate to denounce acts of violence.  Sometimes this is due to their (and their children’s) financial dependence upon the perpetrators, or because police do not take the accusations seriously, or for a number of other reasons.  Add to these the social isolation that many migrants suffer and the fear of deportation, and migrant women are even less likely to report (or to be able to report) acts of violence.

Accusations of sexual violence are even more fraught, as women’s behavior and dress are often scrutinized by authorities as supposed “causes” of or “justifications” for male attacks.  In a recent interview, several Bolivian police officials blamed adolescent girls’ drinking for rising rape rates in La Paz’s Max Paredes neighborhood.  This logic ignores the problem of male perpetrators’ sense of entitlement to women’s bodies, drunk or sober.  Even in countries where activists have made significant gains in raising awareness about rape, such as the U.S., many women’s accusations go unheard.  For example, see this case of a Washington, D.C. woman who was refused a rape kit–valuable forensic evidence that could have put her attacker behind bars (thanks to Feministe for reporting on this story).

An educational comic instructing women on how to report acts of violence to authorities.

In lighter–but still somewhat disturbing–news, RadioFMBolivia.Net published an article this week instructing (implicitly only) men to “caress women’s breasts to satisfy your partner more.” Accompanied by a picture of a large-breasted white woman in a seductive pose, the article, written in a woman’s voice, begins as sex advice and ends as soft porn, as the author finally succumbs to memories of an ex-boyfriend’s expert fingers.

Don’t get me wrong–I am all for frank discussions of sexuality in print, on the radio, on T.V., in the classroom, and anywhere and everywhere else.  However, as I have mentioned before, sex is already surrounded by so many unrealistic and negative messages (ie., that most women can achieve orgasm by vaginal penetration alone; that touching yourself during sex means that your partner is inadequate, etc.), that not just any type of press coverage will do.

This article, for example, gives explicit advice to men on what to do and what not to do in playing with a woman’s breasts: “It is not just about putting your hands on the breasts and moving them quickly and clumsily…  Handling a woman’s breasts requires a certain art, it demands patience.”  But whose breasts are we talking about, here?  Any woman’s?  Every woman’s?  “Sex advice” like that provided by this article actually discourages the one thing required for “good” sex–open and honest communication.  Some women may want their partners to handle their breasts “quickly and clumsily.”  Others may prefer a more delicate touch.  Still others may get no sexual stimulation from having their breasts touched.  But this isn’t something that men (or women who sleep with women) can find out from reading this article.  If you want to know how to turn your partner on, you have to talk to her.

Articles like this one reinforce the idea that sex is something that you are either “good at” or you are not; that there are a set of objective skills that you can pick up and that will work just as well on one partner as on another, and that if you have to ask your partner what she wants, you are somehow inadequate.  I’m not saying this article is totally useless–the soft porn aspect may turn your crank.  But let’s keep porn, porn, and toss out the “one-size-fits-all” sex advice.

Finally, this week Bolivians voted in local (departmental and municipal) elections.  The Andean Information Network has done a superb job summing up the results, so I will not attempt to replicate that here.

As always, I welcome your comments and questions.

3 de Abril: Mejor que un huevito de chocolate

Posted in Bolivia, HPV vaccine with tags , , , , , , , , , , , on April 3, 2010 by eugeniadealtura

This week, the La Paz daily, La Razón, reported on an upcoming campaign to vaccinate 30,000 Bolivian girls between the ages of 9-13 against the Human Papillomavirus (HPV), one of the leading causes of cervical cancer.  The campaign, which will vaccinate girls in five cities and one rural community in Bolivia between April 6-10, is being carried out by the Centro de Información, Educación, y Servicios en Salud Sexual y Reproductiva (CIES) in cooperation with the Ministry of Health.  The vaccinations will be provided without cost, and will be distributed at schools and in public health centers in the areas of highest cervical cancer incidence in the country–El Alto, Oruro, Potosí, Trinidad, Sucre, and in rural areas outside of the city of Sucre.  According to Wilma Pérez, the author of the article, “Bolivia has one of the highest rates of mortality due to uterine cancer in the world,” with “five women dying daily from the disease.”  The World Health Organization reports that cervical cancer is the leading cancer affecting women in Bolivia.

A graffiti penned by El Alto youth at a CIES health and community center, reading, “Let’s prevent STIs.”

According to EhealthMD, poverty and failing to get regular pap test screenings are among the leading risk factors for cervical cancer.  Since women who suffer from cervical cancer generally show few symptoms until the disease is quite advanced, a yearly pap test–which detects changes in the cells of the cervix that can be related to cervical cancer–is the best way to catch the disease early on.  Women who are poor generally know less about the causes of cervical cancer and the importance of yearly screenings, have less access to sexual and reproductive health services, and are frequently malnourished–a condition which also increases the risk of cervical cancer.   Since Bolivia is the poorest country in Latin America apart from Haiti, it is not surprising that it also displays one of the highest rates of death from uterine cancer in the world–according to the WHO study cited above, only 28% of women in Bolivia report ever having had a pap exam.

“Youth Program, ‘You…Decide,’ CIES.”

Although I am as yet unable to provide concrete statistical data on these themes, my own research seems to support the conclusions of the articles cited above.  Since beginning research in Bolivia, I have examined thousands of gynecological and obstetrical records from prominent La Paz and El Alto hospitals stretching from the mid-1950s to 2009.  Anecdotally, I can attest to the fact that the majority of women seen at these facilities across these years report never having had a pap test.  A smaller majority report having had perhaps one or two pap tests across their entire reproductive lives, rather than the yearly test that is recommended.  The number of patients that report to hospitals with advanced cervical cancer seems astounding; many of these women die during their hospital stays.

Another fact that I have noticed in these records, which you can interpret how you like, is this: those women who report having had more than three pap smears in their lives are also more likely to report having used some method of birth control (including the rhythm method), and are more likely to report having had an abortion.

It seems very unlikely that any one of these factors–birth control use, pap tests, or abortions–causes in any direct way any of the other two factors.  Instead, it seems to me that each one of these factors corresponds to a degree of control that women are exercising over their own sexual and reproductive lives.  Women who get yearly pap tests or who use birth control to limit or to space their births are, through these actions, declaring a sense of autonomy over their bodies, sex lives, and reproductive choices.  And women who have abortions, I would argue, are also exercising this autonomy.  Although few women actually want to experience an unwanted pregnancy or to have an abortion, many women who do choose abortion–particularly young women–report that the experience made them more mature, responsible adults, since for many, it was the first time they were forced to make a truly autonomous decision about their lives.  So, perhaps it should not surprise us that women who have had abortions in Bolivia also get pap tests and use birth control.  The conditions of these women’s lives have allowed them access to information and services in sexual and reproductive health, which have given them the tools to exercise control over their own bodies–something that many Bolivian women lack.

A final note: it seems sort of ironic to me that the HPV vaccination campaign has been timed so close to Easter, a holiday that is widely celebrated in the largely Catholic country of Bolivia.  The HPV vaccine has drawn criticism from right-wing and religious elements in other countries due to the belief that girls who are vaccinated–like girls who have access to birth control–will have sex earlier than girls who are not (or do not).  Instead, opponents of the vaccine believe that young people should not be taught about sex, have access to birth control, or be protected from HPV, and that this will simply prevent adolescents from having sex.  This profoundly sex-negative message–which was institutionalized in the U.S. through abstinence-only education in many schools during the Bush years–has proven to only increase rates of adolescent pregnancy and STI infection.  Fortunately, right-wing forces have not derailed the HPV vaccination campaign in Bolivia.  So, during the week following Easter, 30,000 Bolivian girls will receive something much more valuable, though perhaps less tasty, than chocolate eggs.