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Population Connection

„„ Inside This Issue:

Volume 47, Issue 4 December 2015

„„ Abortion Restrictions in U.S. Foreign Aid: The History and Harms of the Helms Amendment „„ For Victims of Wartime Rape, Abortion Out of Reach „„ How the United States Is Hurting Rape Victims Around the World „„ When a Film Becomes a Lifeline

next u.s. president could help of of women and girls with the stroke of a pen



President’s Note


n today’s world there are few problems that can be solved with the stroke of a pen. But what if I told you that the next U.S. president could on day one—January 20, 2017—help tens of thousands of women and girls in the developing world with just one signature? In 1973, Congress, in a backlash to the Roe v. Wade decision, passed a law limiting foreign assistance funding for safe abortion in the developing world. The key word is “limiting.” The law, known as the Helms amendment, bars funding for abortion “as a method of family planning.” This law never had any basis in good foreign or global health policy. Yet it’s still on the books, an offensive echo of our domestic abortion politics that is utterly divorced from the reality of vulnerable people’s lives. The Helms amendment has been consistently misinterpreted to prevent U.S. funds from being used to provide safe abortions to the world’s poorest women even in the cases of rape, incest, or life endangerment—and despite whether local laws allow for those exceptions. Unless and until a U.S. president picks up a pen to clarify this misconstrued policy, women and girls in conflict-ridden regions who have been raped and impregnated by monstrous men and terrorist groups, such as ISIS and Boko Haram, will continue to be denied access to vital abortion care. America’s foreign policy, through the distortion of this law, is telling these traumatized survivors (some of whom are adolescents) that the U.S. government would rather they risk death, suffer unsafe abortions, or bear the pain of giving birth to their attackers’ babies than use funds to safely terminate pregnancies that are the result of horrific circumstances. But, unfortunately, that’s not all. The misapplication of the Helms amendment also makes it difficult for U.S.-funded health organizations to help women and girls deal with the aftermath of unsafe abortions. Why, you ask? Because these organizations are barred from using foreign assistance funds Population Connection — December 2015

to buy the tools and medications that could save women’s lives after botched abortions since those same tools and medications could be used to perform safe abortions. It makes no sense. About 47,000 women die every year as a result of unsafe abortions. Thousands more are forced to continue pregnancies caused by rapists—strangers, soldiers, or relatives. Can you imagine what this means for a girl in Syria or Iraq, where rape is being used as a weapon of war? Even if she manages to flee her crumbling, war-torn country for the relative safety of a refugee camp in neighboring Jordan or Lebanon, she may still have no choice but to risk her life giving birth to her rapist’s baby, all due to the mishandling of an outdated U.S. policy. There is no one in the world who is more deserving of our country’s help than the woman who has escaped the clutches of a demented terrorist, the girl who has been married off to a man three times her age, or the girl whose uncle commits the crime of incest. America’s foreign policy should not be telling these women and girls, “You are on your own.” We should tell them, “We stand with you.” Empowering women and providing the most vulnerable people around the world with access to comprehensive health services—including access to safe abortions—should be a proud cornerstone of American foreign policy and assistance. We’ll be ready with a pen to lend the new president on day one to make that a reality.

John Seager john@popconnect.org

Population Connection Volume 47, Issue 4 December 2015

Board Chair J. Joseph Speidel, MD, MPH Board of Directors Amy Dickson, Duff G. Gillespie, Padgett Kelly, Anna Logan Lawson, Sacheen Nathan, Dara Purvis, Estelle Raboni, Tom Sawyer (Treasurer), Carol Vlassoff, Jo Lynne Whiting (Vice Chair), Hania Zlotnik (Secretary) President and CEO John Seager john@popconnect.org Editor Marian Starkey marian@popconnect.org Contributors Lindsey Bailey, Sneha Barot, Callie Beusman, Carol Bliese, Lauren Boucher, Lauren Carlson, Rebecca Dodelin, Alana Chloe Esposito, Karen Hampanda, Rebecca Harrington, Stacie Murphy, Isabelle Rios, Lisa Russell, John Seager, Marian Starkey Proofreader Skye Adams Population Connection (ISSN 2331-0529) Population Connection is the national grassroots population organization that educates young people and advocates progressive action to stabilize world population at a level that can be sustained by Earth’s resources. Annual membership ($25) includes a one-year subscription to Population Connection magazine. All contributions, bequests, and gifts are fully taxdeductible in accordance with current laws. Population Connection 2120 L Street, NW, Suite 500 Washington, DC 20037 (202) 332-2200 • (800) 767-1956 info@popconnect.org www.PopulationConnection.org www.PopulationEducation.org http://twitter.com/popconnect www.facebook.com/PopConnectAction Cover Photo A little girl at the Gagamari refugee camp in Niger. Nigerians from Damasak fled across the border after their town was attacked by Boko Haram insurgents in July. According to the International Rescue Committee, more than 1.5 million people have been displaced by the ongoing violence in Nigeria. Photo: European Commission Humanitarian Aid & Civil Protection (ECHO)/Wim Fransen


Features 12

Abortion Restrictions in U.S. Foreign Aid


For Victims of Wartime Rape, Abortion Out of Reach


How the United States Is Hurting Rape Victims Around the World

30 When a Film Becomes a Lifeline Departments 2

Editor’s Note


Letters to the Editor


Pop Facts


In the News


The ZPG Society Members


The Good Crisis


Washington View


Field & Outreach

42 PopEd 44 Cartoon 45

Editorial Excerpts

December 2015 — Population Connection


Editor’s Note

“On average, 46 million times a year, women decide they cannot continue their pregnancies and seek abortions. An estimated 21 million of those abortions are unsafe, resulting in approximately 47,000 deaths every year—over half a million women have died in the last decade alone, and millions more have been injured.” —Ipas


or years, I’ve served as a volunteer patient greeter outside of women’s health clinics, first in Falls Church, Virginia, and now in Portland, Maine. At both clinics there is only one day each week when a doctor who performs abortions is present, and on those days a throng of protesters gathers outside, holding gruesome signs and shouting at women and their partners as they enter the clinic. Many of these women are only stopping in to pick up that month’s supply of birth control pills or get their annual Pap test. Others, of course, are there to terminate their pregnancies. I have seen patients break down in tears and turn back at the corner because they were too intimidated by the noisy protesters to proceed through the gauntlet to reach the door. Of course, that’s what volunteer greeters are there for. We shield patients from the cameras trained on them (the protesters take footage that later appears on their Facebook pages), calmly speak words of encouragement, and walk with them through the chaos so that they can enter the clinic as comfortably as possible. That this circus exists each week is a shock to many pedestrians, who often stop to ask us greeters questions. It is difficult for many people to understand why anyone would have such strong convictions about what a stranger should do with her own body. Heck, it’s difficult for me to understand, even after all these years observing the troubling evidence. While abortion in the United States is a hotly contested issue in politics, it is supported by a majority of voters and is constitutionally protected at the federal level (at least for now). The same cannot be said for many countries in the developing


Population Connection — December 2015

world, where the majority of abortions performed are illegal or self-induced, and therefore very unsafe. Adding to the difficulty of receiving safe abortion care in the developing world is the fact that since 1973, U.S. foreign aid has been banned from funding “abortion as a method of family planning, ” even in countries where abortion is legal. The law as it’s written is harmful enough, but its strict interpretation as an outright ban is even worse. The law does not ban abortion in cases of rape, incest, or threat to the woman’s health, but has been interpreted for over 40 years as though it does. Fortunately, this terrible law, introduced by a terribly misogynistic man, Sen. Jesse Helms, can be fixed without the help of Congress—the president (this one or the next) can simply clarify what the law already says. Armed with this fact, Population Connection and its sister organization, Population Connection Action Fund, have begun a campaign to reinterpret and eventually repeal the Helms amendment. We have been collecting signatures and sending petitions to President Obama for over a year already, and, with the help of a media and campaign consultant, will be ramping up our activity in the coming months. The stories you’ll find inside this issue of Population Connection magazine will illuminate just how harmful the Helms amendment has been for women around the world, and how clarifying its intent will help women everywhere.

Marian Starkey marian@popconnect.org

Letters to the Editor

Thanks for the excellent article on the situation in Burundi and the very clear connection between violence and overpopulation in that poor country. A people so culturally tied to the land can see disaster coming when the average plot is less than needed for subsistence. I am puzzled as to why the story of Burundi’s northern neighbor, Rwanda, and the horrible genocide of 1994, did not come up in that article. Jared Diamond, in his book Collapse describes the Rwanda genocide as Malthusian, saying it really had little to do with politics and corruption, and everything to do with food and the land. Prior to the genocide, Rwanda’s land situation was the same as Burundi’s, with each male farming a tiny parcel of land less than one-tenth of an acre. If Diamond is right, and I think he is, then the situation in Burundi is ripe for another round of genocide. Christopher Bystroff, PhD Professor of Biological Sciences and Computer Science Director of the Bioinformatics Program Rensselaer Polytechnic Institute Troy, New York I received a complimentary copy of Population Connection magazine this month, and I loved it. I was truly intrigued by the results of your member water poll. Not surprisingly, the top concern for readers and supporters was that more wars and civil strife will occur because of water and food shortages. I would say your readers are prescient and thoughtful. There is a need to worry about less water and food, more war, and climate change impacts. John L. Hewitt III Simsbury, Connecticut Thanks a lot for the free copy of Population Connection. I think that the issues caused by the enormous number of humans living today are vitally important to understand and act on. Regarding abortion—which I believe should remain legal— women need access to and education regarding effective birth control in order to reduce its incidence. Joe Jagella Williamsport, Pennsylvania www.popconnect.org

Send correspo

ndence to marian@popc onnect.org. Letters are also accepted via postal mail. Le tters may be edited for clar ity and length .

Attn: Marian St Population Co


nnection 2120 L St., NW , Ste. 500 Washington, D C 20037

Re: “Human Population Boom Remains Largest Threat to Africa’s Lions in Wake of Cecil’s Killing” I feel all wildlife is doomed. Humans just don’t seem to understand that too many people hurts everything—including themselves. I hope that people who live in East Africa are learning about birth control at the same time that they are learning how to coexist with lions. But I also realize that seeing the results of a lower birth rate would take so long the lions would probably be gone by then. Bonnie Scott Ravensdale, Washington Many months ago, after watching Hans Rosling’s online presentation on human population, I got the impression that human population stabilization efforts were a well-intended, but ultimately futile, effort. Dr. Rosling’s message fed my (at that time) ambivalent attitude toward population organizations. I was about to let my Population Connection membership expire, but then I watched John Seager’s excellent presentation to the 2015 American Humanist Association conference attendees on YouTube. Seager’s presentation was so compelling that I changed my mind on the matter and immediately renewed by Population Connection membership online. William Cundiff Menomonie, Wisconsin Wow—I am so impressed [by the October issue]! The cover article on Burundi was excellent, but so depressing. I visited Burundi and stayed in Bujumbura 28 years ago. The problems there seem insurmountable, and it seems the likely resolution risks coming with very great tragedy to the nation’s people. You guys are great, and are clearly doing a great job. John Levin Norwalk, Connecticut December 2015 — Population Connection


ABORTION STATISTICS AROUND THE WORLD In the United States, legal induced abortion results in only 0.6 deaths per 100,000 procedures. Worldwide, unsafe abortion accounts for a death rate that is 350 times higher (220 per 100,000), and, in sub-Saharan Africa, the rate is 800 times higher, at 460 per 100,000.

12 The lowest subregional abortion rate is in Western Europe, where abortion is generally legal under broad grounds. There, the rate is 12 per 1,000 women.

32 The abortion rate fell in Latin America from 37 to 31 abortions per 1,000 women between 1995 and 2003; it has held fairly steady since, reaching 32 in 2008.

43 The highest subregional abortion rate is in Eastern Europe, where the rate is 43 per 1,000 women. This reects relatively low contraceptive use, as well as a high degree of reliance on methods with relatively high user failure rates, such as the condom, withdrawal, and the rhythm method.

28 West Africa has an abortion rate of 28 per 1,000 women.

36 Middle Africa has an abortion rate of 36 per 1,000 women.


of abortions in Africa were unsafe in 2008. Source: Induced Abortion Worldwide, Guttmacher Institute and World Health Organization, January 2012 Design by Rebecca Dodelin 4

15 The Southern Africa subregion, dominated by South Africa, where abortion was legalized in 1997, has the lowest abortion rate of all African subregions, at 15 per 1,000 women in 2008.


per 1,000 women

30 20 10 0

Developed World

Developing World

26 In Asia, abortion rates across subregions held steady between 2003 and 2008, ranging from 26 per 1,000 in South Central Asia and Western Asia to 36 per 1,000 in Southeastern Asia.

36 38

Highly restrictive abortion laws are not associated with lower abortion rates. For example: • The abortion rate is 29 per 1,000 women of childbearing age in Africa and 32 per 1,000 in Latin America— regions in which abortion is illegal under most circumstances in the majority of countries. • The rate is 12 per 1,000 in Western Europe, where abortion is generally permitted on broad grounds. Where abortion is permitted on broad legal grounds, it is generally safe, and where it is highly restricted, it is typically unsafe. In developing countries, relatively liberal abortion laws are associated with fewer negative health consequences from unsafe abortion than are highly restrictive laws.


Of the Africa subregions, East Africa has the highest abortion rate, at 38 per 1,000 women.


18 North Africa has an abortion rate of 18 per 1,000 women.

Developed World

Developing World

Unsafe Abortions

The overall abortion rate in Africa, where the vast majority of abortions are illegal and unsafe, showed no decline between 2003 and 2008, holding at 29 abortions per 1,000 women of childbearing age.

Safe Abortions

Nearly half of all abortions worldwide are unsafe, and nearly all unsafe abortions (98%) occur in developing countries. December 2015 — Population Connection





Planned Parenthood of Utah to Continue Receiving Funding, For Now Utah’s governor, Republican Gary Herbert, defunded the state’s arm of Planned Parenthood in September, based on false allegations that Planned Parenthood sells fetal tissue. He preceded this action in August by directing all state agencies to discontinue contracts with Planned Parenthood. The funding Planned Parenthood of Utah receives from the federal government goes toward sexually transmitted infection (STI) testing and treatment, services for victims of sexual assault, and abstinence-only sex education. Ending the contract would leave 4,400 people without STI testing, and 3,725 without STI treatment, according to health department officials. U.S. District Judge Clark Waddoups overturned, via a temporary restraining order, Gov. Herbert’s decision to cut off all $275,000 in funding that the local affiliate receives from the federal government. Judge Waddoups’s decision means that Planned Parenthood will receive funding through the end of 2015.

Crisis Pregnancy Centers Become More Transparent in California Crisis pregnancy centers in California will now find it more difficult to trick would-be patients into thinking they are real medical facilities. By passing AB 775, the state assembly made California 6

Population Connection — December 2015

the first state to force its nearly 170 crisis pregnancy centers to notify patients that there are no medical professionals on staff. Currently, at least 40 percent of the clinics in California are licensed by the state as medical providers, despite the fact that the only medical equipment most of them have on site are pregnancy test strips and ultrasound machines operated by untrained technicians. According to the new law, those clinics that are licensed must provide patients with information about California’s financial assistance for family planning services, prenatal care, and abortion services. Crisis pregnancy centers are run by antiabortion groups and promulgate myths about a connection between abortion and breast cancer. They have also been known to lie to women about the gestational age of their embryos in order to falsely convince them that they are too far along to receive abortion services. The measure passed in the state assembly in May with a large majority and was then signed into law by Democratic Gov. Jerry Brown in October.

Planned Parenthood Will No Longer Accept Reimbursement for Costs of Fetal Tissue Donation Planned Parenthood announced in October that it would no longer accept reimbursement for the costs it incurs by

providing donated fetal tissue to medical research. Only two of Planned Parenthood’s nearly 700 health centers nationwide—one in California and one in Washington State—supply donated fetal tissue to researchers, and only the one in California has been getting reimbursed. Fetal tissue is used to develop vaccines and to research treatments and cures for such diseases as Alzheimer’s, Parkinson’s, and Huntington’s. Fetal tissue research has been conducted since the 1990s, and at one time had bipartisan support. It has been illegal to profit from the donation of fetal tissue since 1993, but it has been permissible for organizations to accept reimbursement for the cost of storing, processing, and shipping the tissue to researchers. Planned Parenthood medical staff only donate fetal tissue to medical researchers with the consent of the woman who had the abortion or miscarriage (late-term fetal tissue is typically from the miscarriage or necessary termination of wanted pregnancies).

Low-income Texan Women to Get Free Birth Control Through New Program Low-income women in Texas will be able, for the first time, to get free birth control from the state through the new Healthy Texas Women program. The program will begin in 2016 and will serve Texans ages 15-44.

In order to qualify, a family’s combined income must be below 200 percent of the federal poverty level—$48,500 per year for a family of four. Texas has the fifth-highest teen birth rate in the country, and the highest repeat teen birth rate. Nearly half of Texas high school students have sex before graduation. Even so, teens will need parental consent in order to receive birth control or any other health service. Outside of the Healthy Texas Women program there are 93 federally funded clinics that provide free or low-cost birth control to minors without requiring parental consent.

Health Care vs. “Religious Freedom” Heartland Christian College and its affiliated addiction recovery center, both based in Missouri; Dordt College in Iowa; and Cornerstone University in Michigan filed lawsuits before the 8th U.S. Circuit Court of Appeals in St. Louis to opt out of extending the birth control benefit in the Affordable Care Act to their employees. The court ruled in the plaintiffs’ favor in Dordt College et al v. Burwell, writing that the birth control benefit violates the rights of religiously affiliated employers by forcing them to cover birth control inadvertently, because opting out requires employers to fill out a simple form.

This decision makes it much more likely that the Supreme Court of the United States will review the contraceptive mandate in the current session, which began in October and runs through June 2016.

China Relaxes One-Child Policy for All Married Couples All married couples in China may now have a second child, regardless of their ethnicity, place of residence, or whether either parent is an only child. The decision was announced in October. The policy was not changed in order to expand personal freedoms to Chinese citizens, but to expand the labor pool. Thirty-five years after instituting the one-child policy, officials are now concerned that the workforce is shrinking relative to the country’s aging population and are hoping to initiate a baby boom. Chinese officials claim that the one-child policy prevented 400 million births, but it’s impossible to know how many of those births would have been averted by economic development, without coercion, as happened in Japan and South Korea, for example. Despite the relaxation of the policy, couples must still apply to have a second child. Analyses of these applications are showing that most eligible couples are opting out because of the immense cost of raising a child in today’s urban China.

Population projections by the UN Population Division and the Population Reference Bureau show that even if most women were to begin having two children starting in 2016, the Chinese population would peak in 2034 at 1.429 billion. The projections show that a continuation of the one-child policy would lead to a peak of 1.346 billion people in 2029. The difference between the two peak projections is 83 million people— the precise amount by which the UN estimates the world population is growing each year.

290 Million Women in the Developing World Are Using Contraception In the three years since the FP2020 effort was launched at the 2012 London Summit on Family Planning, the number of new family planning users in the 69 focus countries has risen by an estimated 24.4 million. There are now 290.6 million women in the focus countries who prevent an estimated 80 million pregnancies, 28.6 million unsafe abortions, and 111,000 maternal deaths each year by using modern contraception. Despite this notable accomplishment, the rate of increase has not been fast enough to reach FP2020’s goal of adding 120 million new family planning users by 2020—the current number is 10 million fewer than the initiative had hoped for by now.

Summarized by Marian Starkey. To read the original news articles, go to www.populationconnection.org/resources/population-news.


December 2015 — Population Connection


Sharon Allen Mahmood Anwar Ginger Bachem & Fritz Bachem William Baker & Susan Baker Aaron E. Barnett Sally Beers Robert Behm & Gayle Behm Keith Berg & Mary Hedblom Lynn Bertucci Rose S. Bethe K. J. Bierman & Jo Ann Bierman Barbara Bird Kathleen Blumenthal John C. Brandt & Dorothy A. Brandt Mark C. Brucker Leonard N. Butters Diane Carlin John Chamberlain

RECOGNIZING MEMBERS OF THE ZPG SOCIETY The ZPG Society honors those who have included Population Connection in their estate plans. We are grateful to our ZPG Society members for their generosity and farsightedness. Thank you! If you aren’t yet a member of the ZPG Society, please consider making a legacy gift to Population Connection. The simplest way for you to ensure that your dedication to population stabilization continues well into the future is through a gift—a bequest—in your will. You can create a bequest by adding just one sentence to your will. And that sentence can make the difference of a lifetime! Contact Shauna Scherer at shauna@popconnect.org for more information.

Holly H. Sanchez Hermann F. Schmid Judith Scott & Paul Thomas Jamie Shaw & Christopher Cope Harry Sherrington & Charity Sherrington William L. Shuman Leon G. Siegel Ken Smith & Kathy Smith John Solso Victor G. Soukup Margaret E. Sowerwine Otto H. Spoerl & Lyne Erving Bella Starmountain-Sweet Richard Stein Lawrence E. Stueck Charlotte B. Swartz Rowland W. Tabor Therese Tanalski Cynthia A. Terra-Starr Irene Wakeland & Robert Wakeland William Warburton Robert Wehle Fredric C. Weihmiller David R. Weindorf Louis Wenckus Jay R. West Jo Lynne Whiting Steve F. Willey & Elizabeth Willey Alice Wolfson Wendy Wollish Wayne Wright Douglas N. Young



Sample Bequest Language: I give and bequeath to Population Connection, at 2120 L Street NW, Suite 500, Washington, DC 20037, _____% of my estate for the general purposes of said corporation. Said corporation’s tax identification number is 94-1703155.



Lane Hoxworth Agnes Hughes Stephen Hunter John Hutcherson Michael Ihlenfeldt Rosalie Jacobs Heidi Johnson Alan E. Johnsrud Cheryl Jurrus Paul H. Kaser Ann Peckham Keenan Vicky Kemp & Grant Kemp Douangmala Khounnavongsa Justine Kirk Hunt Kooiker & Linda Kooiker Michael E. Kraft & Sandra K. SimpsonKraft James E. Kunz Dorothy Leong & Andy Leong (In Memory of Rebecca Yee Hun Leong Lau) Jeff Lesak & Merrily Swoboda Merle K. Lewis John Lochhead Douglas Longman Dwight E. Lowell & Kimberly F. Lowell Norman Mandelbaum Craig Mandsager Nancy Marvel Christopher Mathews & Catherine Mathews T.D. Mathewson David R. Matteson & Sandra Matteson Elaine McAuliffe Landon B. McDonald Guy Merckx G. Robert Miller Larry D. Miller Peter Mitchell Emmet V. Mittlebeeler Russell Moffett Barbara Q. Myers Edith Neimark James P. O’Callaghan Ruth W. Page Mariette Parent & Arthur Parent Ronald G. Parker Bob Pettapiece Frank A. Pezzanite & Judy C.M. Pezzanite Felicity Pool Gladys Powers Denise Powers Curtis C. Ridling Carrie Robertson


David Chelimer & Lynne Chelimer Michael F. Cieslak Harriett Clark Paul G. Clarke Audrey Clement Melvin Cohen Carl Coleman Guy E. Dahms Allan L. Daniel & Kendra Daniel Ginny Darvill Richard S. Dennison & Diane Dennison Debbie Dill Raymond H. Dominick Julian Donahue & Katharine Donahue Fay Dresner Richard M. Dubiel Lyn DuMoulin Lee Dunn & Tharon Dunn Nancy Farrell-Rose Daniel Fearn & Kirsten Fearn Robin R. Friedheim Doug A. Gardels Don C. Gentry Susan Gerber Paul L. Gerhardt & Barbara Gerhardt Forrest Gilmore Marion P. Goodale Robert M. Goodwin & Margaret L. Goodwin Eric Gordon James Griffith Gary Harrold Dwight B. Heath & Anna Heath Nancy Heck Dan Heisman & Shelly Hahn Steve Henigson & Jean Henigson Max Heppner William W. Hildreth Regina Holt Alfred Hoose




December 2015 — Population Connection


Coming in January 2016!

The Good Crisis:

How Population Stabilization Can Foster a Healthy U.S. Economy

We are pleased to announce the release of our first book! The Good Crisis: How Population Stabilization Can Foster a Healthy U.S. Economy features contributions by leading experts in aging, demography, public health, environmental science, and steady state economics. The Good Crisis proposes that initiating progressive social and economic changes alongside population stabilization can promote economic prosperity— increased birth rates are not required. Since the 1970s, Americans have had small families on average. Our national fertility rate is now just below replacement rate, at 1.9 children per woman. Ben Wattenberg, Phillip Longman, and Jonathan Last have all argued that a low birth rate spells economic and social disaster. Our book stands as a counterpoint to this “birth dearth” myth. It demonstrates how the United States can leverage population stabilization by ensuring that Americans gain access to better education and healthcare, by preventing teen pregnancy, and by welcoming marginal groups into the workforce. The Good Crisis shows that we can foster a healthy economy while protecting our natural resources from unsustainable population growth.

For more information, visit us online at: www.thegoodcrisis.org

10 Population Connection — December 2015

Contributors Katherine Baicker

Jay W. Lorsch

Noah Berger

Hal Marcovitz

David E. Bloom

Robert D. Plotnick

David Cutler

John Seager

Brian Czech

Zirui Song

Herman Daly

Alan Weisman

Peter Fisher Matt L. Huffman Lori M. Hunter Ronald Lee

Editors Lee S. Polansky John Seager

Excerpt from David E. Bloom The U.S. population will continue to grow at a robust pace in the decades ahead, ensuring a steady flow of new entrants to the workforce. But the combination of population aging and the fact that low-education and low-skill racial and ethnic minorities will make up an everlarger portion of the workforce is raising worries about future worker and skill shortages and about the macroeconomic performance of the U.S. economy… But demography need not be destiny. As ongoing political debates highlight, there are wide-ranging views of the public and private policy options that offer the most potent means of adapting


to the new demographic contours of U.S. society. These include finding the means and will to control health costs for the aging population. They also must consist of educational policies at the federal and local levels that encourage learning that meets the needs of our changing workforce and the technological demands they will confront at work, whether in manufacturing or service jobs… … The predictability of demographic trends is a powerful tool in policymakers’ arsenal. Being able to peer into the crystal ball improves our capacity to plan and devise both proactive and reactive strategies for heading off problems and taking advantage of potential opportunities. In that way, the demographic lens can help guide us to the economic future to which we aspire.

December 2015 — Population Connection 11

Abortion Restrictions The History and Harms of the By Sneha Barot Originally published in the Guttmacher Policy Review


Forty years ago, in the wake of Roe v. Wade, Congress enacted the Helms amendment to restrict U.S. foreign aid from going toward abortion. Specifically, the policy prohibits foreign assistance from paying for the “performance of abortion as a method of family planning” or to “motivate or coerce any person to practice abortions.” Just on its face, the law is extreme and harmful. But its damaging reach has extended even further through the chilling impact it has had—on lawful abortion-related activities in particular, as well as more generally on U.S. sexual and reproductive health programs overseas. As such, supporters of women’s reproductive health are eager to see the law overturned altogether. However, given the impossibility of repealing this long-standing abortion restriction in the current political climate, there are steps that the administration can take in the interim to mitigate the impact of the Helms amendment.

In Roe’s Aftermath

The Supreme Court’s momentous 1973 decision recognizing a constitutional right to abortion in Roe v. Wade nationalized the issue of abortion, galvanized the existing antiabortion movement, and led antiabortion activists to mobilize at the federal government level as never seen previously. That year, lawmakers introduced an unprecedented number of measures to cut off access 12 Population Connection — December 2015

to abortions domestically and globally. Their two-pronged strategy focused on overturning Roe through constitutional amendment and, alternatively, at least reducing the availability of legal abortions by cutting off all federal government support for abortion care, including through U.S. foreign aid. The constitutional amendment route failed to gain traction, but antiabortion forces found success in defunding abortion and excluding it from federal health programs. An early victory for the antiabortion forces came with the 1973 passage of the Helms amendment to the Foreign Assistance Act—a provision named for its sponsor, the late, stridently antiabortion Sen. Jesse Helms (R-NC). While the debate over the Helms amendment raged in Congress, the Nixon administration’s U.S. Agency for International Development (USAID) issued a statement to Congress expressing its strong opposition. USAID protested that following an era of decolonization, this new restriction was at odds with the fundamental philosophy of U.S. population assistance policy, because of its seemingly imperialistic and hypocritical overtones. Moreover, even at that time, programmatic and technical experts from within and outside the U.S. government considered the provision of safe abortion services to be an integral component of any broader program involved with reproductive

in U.S. Foreign Aid Helms Amendment

Halima, 17, fled the occupied town of Gwoza in northeastern Nigeria days before a military assault forced Boko Haram to retreat in March 2015. She said her mother paid a people smuggler from the nomadic Fulani tribe to lead her on bush paths to Mubi, a city that is under government control. Photo: Jerome Starkey


December 2015 — Population Connection 13

health care. The agency also implied that the effect of removing safe abortion from the range of options provided to women with unintended pregnancies— an option just legalized for U.S. women nationwide—could amount to a form of 14 Population Connection — December 2015

coercion. The Foreign Assistance Act, USAID wrote, “explicitly acknowledges that every nation is and should be free to determine its own policies and procedures with respect to population growth and family planning. In contradiction

of this principle, the amendment would place U.S. restrictions on both developing country governments and individuals in the matter of free choice among the means of fertility control … that are legal in the U.S.”

on lobbying for or against abortion. (Congress also clarified the Helms amendment in the early 1990s to say that information and counseling about all pregnancy options, including legal abortion—consistent with local country law—is a permissible activity within USAID funded programs.)

Ruth Jacobson is a displaced person staying at Sainte Therese’s informal settlement in Niger. Boko Haram killed her husband in Nigeria. Photo: EU/ECHO/Isabel Coello

The Helms amendment took effect at the end of 1973. Historically, it followed the first federal abortion restriction, which was enacted in 1970 under the domestic family planning program, and preceded its domestic analogue, www.popconnect.org

the Hyde amendment, first enacted in 1976. The passage of the Helms amendment spurred the enactment of several other prohibitions in the foreign assistance realm, including bans on federal funding for biomedical research and

Restrictions on U.S. development and humanitarian programs have also come in the form of executive policy, most notably the Mexico City policy, also known as the Global Gag Rule. This policy is important to the story of the Helms amendment because of the additional ways it has burdened access to safe abortion care for women in developing countries beyond Helms. The presidential order—first instituted in 1984 by President Ronald Reagan— prohibited foreign nongovernmental organizations (NGOs) that receive U.S. family planning assistance from using non-U.S. funding to provide abortion services, information, counseling, or referrals and from engaging in advocacy to promote abortion. Since Reagan, the policy has been implemented by every Republican president and revoked by every Democratic president, including Barack Obama. While the Helms amendment limits the use of U.S. foreign aid dollars directly, the Gag Rule went far beyond that by disqualifying foreign NGOs from eligibility for U.S. family planning aid entirely by virtue of their support for abortion-related activities subsidized by non-U.S. funds.


Addressing the Harms of Unsafe Abortion

Because of the Helms amendment and related abortion restrictions, the U.S. government has limited its ability to fully address the problems of unsafe abortion and maternal mortality and morbidity. Every year, millions of women

December 2015 — Population Connection 15

suffer serious injuries from unsafe abortion, and 47,000 of them die—almost all in the developing world. Unsafe abortion is a significant driver of maternal mortality: It is responsible for 13 percent of maternal deaths worldwide and represents one of the four major causes of pregnancy-related mortality and morbidity. In certain regions, such as Africa or Central and South America, almost all abortions are unsafe, defined by the World Health Organization (WHO) as an abortion performed by an individual without the necessary skills, or in an environment that does not conform to minimum medical standards, or both. Consequently, WHO identifies safe abortion care as one of seven necessary packages of interventions to ensure quality reproductive, maternal, neonatal, and child health care. In its technical and policy guidance on safe abortion, WHO notes that imposing abortion bans does not stop nor necessarily even lower abortion rates. In fact, research shows that the abortion rate in Africa and Latin America (29 and 32 per 1,000 women aged 15-44, respectively), where abortion is illegal under most situations in most countries, is actually much higher than in Western Europe (12 per 1,000), where abortion is broadly legal. Rather, the major impact of criminalizing abortion is to force women to undergo unsafe and clandestine procedures to terminate their unwanted pregnancies, which results in death and disability. There are at least three ways to reduce the incidence of unsafe abortion and its consequences: First is the provision of family planning services to prevent unintended pregnancy, the root cause of most abortions. Second is access to safe abortion care to prevent women from having to resort to unsafe abortion. And last is the availability of emergency 16 Population Connection — December 2015

or postabortion care for the treatment of incomplete or unsafe abortion. The United States supports the first and last prongs. Indeed, it is the leading donor in the field of international family planning and reproductive health and funds programs in more than 40 countries—the majority of which permit abortion under at least one or more circumstances. Yet, the U.S. government is ineffectively and incompletely addressing unsafe abortion by failing to support the middle prong: safe abortion services.

For example, USAID has adopted an overly restrictive interpretation of the amendment as requiring a ban on the purchase of equipment and drugs to aid in postabortion care, such as manual vacuum aspiration (MVA) kits to treat incomplete abortions and misoprostol to treat postpartum hemorrhage. This decision has contributed to shortages in life-saving resources, and to an incomplete and inconsistent approach to addressing unsafe abortion injuries. On


Every year, of women suffer serious injuries from unsafe abortion, and —almost all in the developing world.

47,000 of them die

Climate of Hostility

Helms and the related abortion restrictions do not merely interfere with the U.S. government’s ability to address unsafe abortion and maternal mortality and morbidity. These restrictions, collectively, have resulted in a perception that U.S. foreign policy on abortion is more onerous than the actual law. Organizations such as Ipas, an NGO that supports safe abortion access, have documented the chilling impact of Helms and other U.S. abortion restrictions abroad. Specifically, they point to a pervasive atmosphere of confusion, misunderstanding, and inhibition around other abortion-related activities beyond direct services. Wittingly or unwittingly, both NGOs and U.S. officials have been transgressors and victims alike in the misinterpretation and misapplication of U.S. anti-abortion law.

the one hand, USAID provides training on the treatment of complications of unsafe abortion through MVA use; on the other hand, the agency will not actually purchase the equipment to make treatment a reality. For their part, whether through misinterpretation or self-censorship, NGOs are needlessly refraining from providing abortion counseling or referrals in health facilities for women with unwanted

pregnancies, including those who have been sexually assaulted; incorporating abortion information in websites, training materials, and other publications; participating in discussions and meetings on unsafe abortion; and partnering or identifying with NGOs that openly support abortion access.

Mitigating the Harm

Because of the harm, both direct and indirect, of the Helms amendment

and related abortion restrictions, legislative repeal of these provisions is the long-term goal of advocates of women’s reproductive health and rights. In the short term, however, the administration has the power to moderate the impact of Helms in a small but significant way without the involvement of Congress, by allowing foreign aid funding to be used for abortion services—where legal—for women who experience rape, incest, or a life-threatening emergency.

Ten-year-old Sema was captured by Boko Haram and held captive for eight months, until she managed to escape one night by following two older women. She saw with her own eyes men being slaughtered. She is staying with her grandmother at Sainte Therese’s informal settlement in Niger. She feels safe here, she says. But she still has nightmares. Photo: EU/ECHO/Isabel Coello


December 2015 — Population Connection 17

Access to abortion services is especially critical for survivors of sexual violence and is, in fact, considered by international and medical authorities to be an integral aspect of a comprehensive response for rape victims. A new WHO report that highlights the global epidemic of violence against women, including sexual violence, strongly urges a more active and holistic response to this problem from the health sector. Complementary clinical and policy guidelines released with the report call for the provision of comprehensive sexual and reproductive health services for sexual violence survivors, including, when appropriate, emergency contraception to prevent pregnancy; HIV post-exposure prophylaxis to prevent infection; STI prophylaxis and treatment; and abortion, when allowed under national law. Among the most vulnerable victims of sexual assault and those in most dire need for comprehensive health services are women raped in armed conflict and other crises. Despite increasing international attention over the last 15 years to the plight of these women, such sexual crimes continue with impunity and without adequate response for survivors. In his most recent annual report on sexual violence in conflict, the United Nations (UN) Secretary General states that safe abortion access must be part of any multisectoral response for women impregnated through rape. Similarly, the authoritative field manual on the provision of reproductive health services in crisis settings, developed by a UN interagency collaboration, delineates a set of minimum interventions and service delivery guidelines to be put in place, including the provision of safe abortion care to the extent allowed by law. It notes that the lack of access by those in crisis to “comprehensive abortion care is a denial of their equal rights and protection as 18 Population Connection — December 2015

mandated under international human rights law.” The administration possesses the power to render the U.S. policy on abortion overseas a little more humane, at least in these types of dire circumstances. A fair reading of the language of the law

Moreover, as a political matter, a correct reading of the Helms amendment would bring it in line with the federal status quo on abortion restrictions, as well as the current political consensus among both Congress and the American electorate. Specifically, almost all federal programs that restrict abor-


Because of the , both direct and indirect, of the Helms amendment and related abortion restrictions, of these provisions is the of advocates of women’s reproductive health and rights.

legislative repeal long-term goal prohibiting payment for “abortion as a method of family planning” would allow support for abortion in certain cases. Indeed, the 1985 rules issued by the antiabortion Reagan administration originally implementing the Mexico City policy confirms this understanding, by stipulating that the phrase excludes “abortions performed if the life of the mother would be endangered if the fetus were carried to term or abortions performed following rape or incest (since abortion under these circumstances is not a family planning act).” More recently, the George W. Bush administration affirmed this interpretation in its legal guidelines on execution of the Global Gag Rule. Hence, a true application of this language would mean that, at the very least, the Helms amendment allows foreign aid for abortions for rape, incest, and life endangerment cases— and could arguably include abortions for health reasons.

tion funding—including Medicaid, the Indian Health Service, health care for women in federal prison, and the Federal Employees Health Benefits Program— make explicit exceptions for the extreme cases of rape, incest, and life endangerment. And, most recently, the military’s TRICARE insurance program was added to this list: Congress passed the defense authorization bill in December 2012 with an amendment authored by Sen. Jeanne Shaheen (D-NH) that garnered bipartisan support to expand abortion coverage for women in the military and female dependents to cases of rape and incest. Notably, the Helms amendment is among the few remaining abortion restrictions that do not meet this federal minimum standard. (The other conspicuous exception is the legislative ban affecting abortion coverage for Peace Corps volunteers, which some members

Amina Aboukar, a Nigerian refugee from Damasak. Nigerians fled across the border with Niger when insurgents of Boko Haram attacked their town in November 2014. The makeshift camp of Gagamari in the Diffa region of Niger counts 16,000 refugees. Following a string of attacks along the border, the government of Niger has declared a humanitarian emergency and asked organizations for help in setting up camps. The violence in northeast Nigeria has resulted in the displacement of 150,000 people to neighboring countries—a majority of whom are now in Niger—and over 1.5 million people within Nigeria. The European Commission Humanitarian Aid and Civil Protection (ECHO) supports various UN agencies and NGOs to provide urgently needed assistance, but needs are immense and access is difficult. Photo: EC/ECHO/Anouk Delafortrie


December 2015 — Population Connection 19

of Congress are trying to rectify.)1 Moreover, it is the only one that can be fixed through administrative action, and there is a strong argument to be made that aligning the Helms amendment with other federal programs should not be such a heavy political lift. Indeed, even some of the fiercest antiabortion actors in Congress have conceded that insisting on abortion bans that do not allow exceptions for rape, incest, and life endangerment cases is politically untenable. The rationale for a revised and corrected policy on Helms implementation stands on solid ground on all accounts—from a public health, legal, and even political basis.

Three of the schoolgirls who managed to escape when Boko Haram abducted 276 of their classmates from the Government Secondary School in Chibok, Nigeria. They are now studying at the American University of Nigeria in Yola. Deborah, 19, Blessing, 17, and Mary, 17, (left to right) said they had tried to forgive the insurgents, whom they said were illiterate and unemployed. “Even though they have done so much destruction, to me punishing them will not be the best answer,” said Deborah. The girls identified themselves by middle names, for fear that their parents in Chibok might face reprisals from the insurgents. Photo: Jerome Starkey

Catching Up

NGO partners in global health who have experience with the U.S. government’s family planning and reproductive health program are ready and eager to help implement a revised policy on Helms. Some of these NGOs currently provide or advocate access to safe abortion services with other donor funding, and from their work on the front lines of serving some of the world’s poorest women in distress, witness the need for a more humane U.S. abortion policy abroad. Although other donors, such as the United Kingdom, the Netherlands, Sweden, and Norway, are taking the lead in tackling the problem of unsafe abortion and promoting comprehensive reproductive health care, they do not have the reach—and therefore, the impact—of U.S. global health assistance. Moreover, their contributions do not release the United States from its own responsibilities to implement a global health program that is evidence-based, comprehensive, and responsive to real women’s needs. A reinterpreted policy would, at a minimum, bring the U.S. abortion policy overseas up to the same standard applied to other federal programs and would represent parity for women receiving U.S.-supported reproductive health services overseas compared with those receiving services domestically. But, beyond that, a policy change could send an important signal to other governments, donors, and NGOs that the United States recognizes that there is a role for safe abortion in promoting women’s reproductive health. No matter how limited the U.S. involvement in abortion activities resulting from a slightly softened interpretation of the Helms law, the fact that there would be some movement could help reduce stigma around abortion. It could help thaw the chilling effects of and diminish the hostile climate toward abortion long associated with the United States. This would represent a modest but critical step in reforming 1

In December 2014, this ban was overturned when the U.S. Congress passed a $1.1 trillion spending bill that included the Peace Corps measure— volunteers now have access to abortion care in cases of rape, incest, and life endangerment. —Population Connection

20 Population Connection — December 2015

U.S. abortion policy overseas, so that it is a legally accurate interpretation of the law, reflects the minimum standpoint on abortion restrictions among policymakers and the public, and serves the very real needs of women in the developing world. Originally published: Barot S, Abortion restrictions in U.S. foreign aid: The History and Harms of the Helms Amendment, Guttmacher Policy Review, 2013, 16(3):9-13 www.guttmacher.org/pubs/gpr/16/3/gpr160309.html


“Indeed, even some of the actors in Congress have conceded that insisting on abortion bans that do not allow exceptions for rape, incest, and life endangerment cases is .�


politically untenable

December 2015 — Population Connection 21

For Victims of Wartime Rape, By Alana Chloe Esposito Originally published on Women’s eNews

Here’s what one Kenyan woman says about being forced to carry through a pregnancy that resulted from a rape during a conflict period. Obama could end such suffering by clarifying that U.S. law actually does allow abortion funding in such circumstances, a health activist says.


n March, Jacqueline Namuye Mutere, a citizen of Kenya, was scheduled to participate at a panel here on the role of donor governments in responding to conflict-related rape. Due to a visa problem, however, she was denied entrance to the United States and could not make the panel, where she was going to give a personal account of being victimized by rape during a period of violent conflict. Determined to make others understand why she so desperately wanted an abortion when she became pregnant, she spoke with Women’s eNews recently via Skype and told her story. Mutere had been working in Nairobi as a community developer to empower people with information and tools for personal and community advancement. She also consulted on HIV prevention and treatment until she was raped in January 2008, during a spate of violence following a disputed election in Kenya. “My life became very difficult. My health went down,” she said. “I had just given birth to my fourth child less than a year before. My body wasn’t ready to go through another pregnancy. And I didn’t want anyone to know I was pregnant so I tried to hide it. And the mental

22 Population Connection — December 2015

An eleven-year-old rape victim is shown on her way to a session with a caregiver at a safe house in Monrovia, Liberia. Photo: UN Photo/Staton Winter

Abortion Out of Reach


December 2015 — Population Connection 23

Jacqueline Mutere, survivor, advocate, and founder of Grace Agenda in Kenya speaks at the Faith Leaders’ Summit hosted by CHANGE and RCRC, urging President Obama to break barriers to post-rape care overseas. Photo: John Nelson Photography

pressure of hiding something, while at the same time feeling my body growing, that affected me very much. I didn’t eat or sleep well and started losing weight.” Being a widow, Mutere said things were hard financially. “I was worried about how I was going to feed this child when I already had a 1-year-old and three other children in the house. I could no longer work because I was too weak physically and mentally so I had no income and an extra mouth to feed.” 24 Population Connection — December 2015

Mutere said the stress was causing her to lose her grip. “I was sliding into depression, was easily agitated, and would sometimes become hyper and go into fits and tantrums. It was an emotional roller coaster and I couldn’t take it anymore. That’s when I decided to have an abortion.” Rape is wielded as a weapon of war in 21 countries, according to a UN report released last year.

For victims in these countries, research has shown that access to comprehensive post-rape care is crucial to any hope of recovering physical, mental, and emotional health. It must include, according to another report issued by UN Secretary-General Ban Ki-Moon, access to “the safe termination of pregnancies for survivors of conflict-related rape.” Without it, women, if they survive, suffer from lasting consequences that affect

their ability to earn a living, care for their children, and generally prevent them from piecing their lives back together.

order clarifying U.S. foreign assistance is allowed to support abortion access in cases of rape, incest, or life endangerment.

Hindered by U.S. Funding Law

Sippel said there has never been an official legal interpretation of the Helms law, “so we are asking President Obama to get his lawyers together and do this.”

Nongovernmental organizations such as Medécines Sans Frontières (Doctors Without Borders) do their best to provide such care, but their efforts are hindered in part by U.S. foreign assistance laws that restrict funding to reproductive health facilities that provide abortion services abroad. In January 2009, President Barack Obama rescinded the so-called Global Gag Rule—a law formally called The Mexico City Policy—that bars U.S. foreign assistance to any activities of health facilities that provide abortion services. However, a lesser-known similar law has remained in effect since its adoption in 1973. The Helms amendment to the Foreign Assistance Act of 1961, named for its author, the late Sen. Jesse Helms, does not technically prohibit funding to service providers who perform abortions in cases of life endangerment, incest, or rape. The Helms amendment only states that no U.S. aid can fund providers of abortion “as a method of family planning.” Yet, the policy has always been applied, and continues to be applied, more broadly, with devastating consequences for victims of sexual violence.

“If the president of the United States of America says that women and girls who are raped in conflict deserve access to these services to restore their lives, that is a tremendous step for human rights,” she said in an interview at the UN.

Restrictive Laws

In the Skype interview, Mutere said that after consulting with a doctor, she scheduled an appointment for an abortion through a local health clinic that regularly and safely provided such services. However, Kenya’s abortion laws are among the most restrictive in the world (even after the 2010 constitution relaxed them slightly) and the government had begun cracking down on abortion providers. On the appointed day, Mutere found her clinic closed. She could not afford to get an abortion at the hospital, the only other safe provider of which she was aware. So she decided to carry the baby to term and give it up for adoption.

Even the Global Gag Rule, which in many respects was a more restrictive law, specified exceptions for cases of rape, incest, and life endangerment.

“My story is not the story of other women, who try to obtain an abortion even when it is unsafe,” Mutere told Women’s eNews. “Some have botched abortions and give birth to children with disabilities or they end up with life-threatening diseases or conditions because they get infected and develop sepsis.”

Serra Sippel, president of the Center for Health and Gender Equity in Washington, D.C., hopes Obama, before leaving office, will issue an executive

Without access to comprehensive postrape care, women already suffering from conflict and the trauma of rape often seek abortions from unsafe providers if


they become pregnant. This accounts for roughly 13 percent of all maternal deaths worldwide, according to the World Health Organization. Mutere gave birth to a healthy little girl named Princess on November 12, 2008. Ultimately, she decided to keep her baby, but she continued to suffer. “After giving birth, I was very ill,” she said. “I was discharged from the hospital, but went back a week later with an infection and stayed for three months. When I finally came out, I started my recovery process. I went for counseling. I got in touch with myself. I did meditation. It took the whole year to heal myself.” At the counseling sessions, Mutere met other survivors. “They were really, really defeated and had no options in life whatsoever. Some talked about how they hated their babies and even abused them. They were depressed and expressed a lot of aggression.”

Grace Agenda

Her experiences inspired Mutere to form a community-based group that helps rape victims heal and supports other groups in the community working to counter gender-based violence. She named her group Grace Agenda. Grace has many definitions, but for Mutere, it means strength. Initially there were just five other women in the group. “I encouraged them to open up and learn not to transfer their trauma to the child. Gradually they did. From there, I started working with women with disabilities. Some had mental disabilities, others physical. All had been raped as a consequence of being disabled, either because they couldn’t comprehend what was going on when the perpetrator December 2015 — Population Connection 25

approached them, or because they couldn’t run away as fast as their peers.” Grace Agenda was founded in 2010 and formally incorporated in 2013. In addition to its Nairobi headquarters, it has an office in the multiethnic town of Busia, near the Ugandan border, where many people suffered ethnically targeted violence triggered by disputes over the 2007 presidential election results.

26 Population Connection — December 2015

Grace Agenda also advocates for reparations in accordance with a report submitted to the government in 2013 by the Truth and Justice Reconciliation Commission, which was established in 2008 by an act of the Kenyan Parliament. That report recommends reparations for all victims of human rights violations in Kenya that have occurred since the country gained independence in 1963.

nongovernmental organization based in Washington, D.C., Grace Agenda is trying to pressure the government to carry out the report’s recommendations.

In partnership with the International Center for Transitional Justice, a

“Once or twice I did engage with the National Gender Equality Commission

Mutere is upset that neither she nor any other rape victims have been invited to weigh in on the discussion of reparations, despite proactively seeking out opportunities to do so.

Rev. Harry Knox (center), president of the Religious Coalition for Reproductive Choice (RCRC) is joined by Serra Sippel, president of the Center for Health and Gender Equity (CHANGE), faith leaders, and human rights advocates at a June 2015 news conference across the street from the White House calling on President Obama to take executive action on access to safe abortion for women and girls raped in conflict. Photo: John Nelson Photography

to discuss what parameters would be used to determine compensation if reparations are ever granted,” she said. “It is not easy to assign a value to suffering. If a woman who has disabilities or is HIV positive is raped and gives birth, what can be done to repair her life? Would you give her a voucher for health care? What about the children? How do you take care of children who are born as a result of political conflict?”


Mutere said the state ought to be responsible for the offspring too. “The commission recommended an annual stipend for 10 years,” she said, “but my question is: How does this compensate the woman? What value are you adding to her life because she has this child? And what happens to the child? The child needs education, needs to eat and sleep and to be taken care of and to live a good life.”

Alana Chloe Esposito is an independent writer interested in international humanitarian and human rights law, development and cultural diplomacy. She is the UN correspondent for Women’s eNews.

December 2015 — Population Connection 27

How the United States Is Hurting Rape Victims Around the World By Callie Beusman Originally published on Broadly

The Helms amendment stipulates that U.S. foreign aid can’t support abortion “as a method of family planning.” But it’s been interpreted as a total ban on abortion—including in cases of rape and threat to the mother’s life.


onica Oguttu is the CEO of KMET, a Kenya-based organization that works to ensure that underserved communities can access quality reproductive health care services. When rape victims come to KMET clinics in need of assistance, the providers there provide them with numerous resources: emergency contraception, post-exposure prophylactics, and counseling. But if a patient returns later saying she’s pregnant, there’s nothing Monica or her colleagues can do. “I [have to tell] these women that we can’t help them, even knowing their pregnancies are due to rape,” she told Broadly in a Skype call. “It’s really frustrating, seeing a woman crying in front of you, and later you meet her in a hospital [suffering from] unsafe abortion complications.”

A woman dies every 11 minutes from unsafe abortion; every year, millions more sustain serious injuries because they cannot access safe and legal services. Despite this, the U.S. government continues to impose several restrictions on overseas funding for abortion. One of the most onerous regulations in place is the Helms amendment, first enacted in 1973. On paper, it prohibits U.S. foreign assistance from supporting abortion “as a method of family planning.” For years, though, it’s been interpreted as a complete ban on funding for all abortion-related services—even in cases of rape, incest, and threat to the mother’s life. This has serious repercussions for women around the globe—according to Jonathan Rucks, the director of advocacy at PAI, “U.S. government-funded reproductive health programs serve millions of women in over 45 countries.” In all of Monica Oguttu Photo: Peter Schnurman, longtime volunteer at KMET

28 Population Connection — December 2015

these countries, abortion is legal to save a woman’s life; in “about half,” abortion is permitted in cases of rape and incest. “In countries where abortion is legal or is permitted in the cases of rape or incest, the current interpretation of the Helms amendment serves as a direct barrier to critical care for survivors of sexual violence,” Rucks said. What’s perhaps most appalling about the Helms amendment is the fact that it even applies to women in conflict areas, who are often subjected to rape as a form of torture. Because of Helms, humanitarian groups cannot use federal funding to provide safe terminations to pregnant victims of wartime rape. The policy is especially malignant in light of recent reports that the Islamic State considers rape central to its ideology and that some Boko Haram sect leaders “make a very conscious effort” to impregnate the women they subject to sexual violence. The Washington Post has called Helms “inhumane,” citing the “horror and prevalence of rape as an instrument of war” as proof that the policy must change. The New York Times, too, has condemned the law, and the United Nations Human Rights Council recently asked the U.S. government to “explain its failure to address its misapplication of the Helms amendment.” Still, executive inaction remains the norm.

A KMET health worker teaching local women about their different family planning options. Photo: Peter Schnurman, longtime volunteer at KMET

“President Obama has the power to save women’s lives and end the unnecessarily broad interpretation of the Helms amendment,” said Rucks. “Unfortunately, despite the president’s track record on women’s rights—and the urging of numerous U.S. and international NGOs—he has chosen not to act on Helms.” In addition to forcing victims of rape to carry unwanted pregnancies to term, the Helms amendment prevents NGOs from providing proper medical attention to women who’ve undergone unsafe, illegal abortion procedures. According to a 2013 Guttmacher report, the U.S. government’s “overly restrictive interpretation” of Helms has resulted in a general ban on “the purchase of equipment and drugs to aid in post-abortion care.” This has devastating effects on women’s health, especially in rural areas where women have little to no access to safe abortion services. According to the report, the current interpretation of Helms “has contributed to shortages in life-saving resources, and an incomplete and inconsistent approach to addressing unsafe abortion injuries.” “[The U.S. Agency for International Development] USAID offers funding to train in family planning and post-abortion care, but you cannot use the funding to buy the supplies,” said Oguttu. “Everybody knows that training alone is not enough. You need to equip the providers to offer the services.” www.popconnect.org

Although the providers at KMET clinics are thoroughly trained in post-abortion care, Oguttu said, that training is essentially “meaningless” without the proper equipment. Reproductive health organizations operating in areas with high rates of unsafe abortion need manual vacuum aspiration (MVA) kits in order to treat incomplete abortions, as well as access to misoprostol, a medicine used to treat postpartum hemorrhage. Without MVA kits, providers have to “digitally evacuate the product,” Oguttu said, meaning they must use their hands in place of medical equipment—which is far less safe, obviously, and far more likely to result in potentially life-threatening side effects, including heavy bleeding and septic shock. Forty-seven thousand women die per year of complications from unsafe and illegal abortions; the most common causes of death are hemorrhage, infection, sepsis, genital trauma, and tissue death of the bowels. “With the recommended MVA kit, within fifteen minutes you are done, you have saved that life, and she’s stable,” said Oguttu. “This is

what we are not allowed to buy with the USAID funding.” But Oguttu is optimistic that things can change. If the United States simply changes its interpretation of Helms, she noted, humanitarian organizations overseas would immediately be able to offer significantly improved services to women in need. “There would be access to safe abortion, there would be destigmatization of abortion, and we’d have supplies and equipment in place to offer these services,” she said. In Kenya, as everywhere else, restricting abortion access does not prevent abortion from happening: It simply puts safe abortion out of reach for those who can’t afford it. “If you have money anywhere in Africa or Kenya today, you can access safe abortion because you can buy the services,” Oguttu said. “But what about the poor women who have no money? That is why we keep fighting: Because these poor voiceless women are dying silently without anybody listening to their cry.”

December 2015 — Population Connection 29

When a Film Becomes a Lifeline By Lisa Russell, MPH Photos by Lisa Russell, unless otherwise noted

30 Population Connection — December 2015


n 2004, the Ethiopian Parliament made the bold decision to decriminalize abortion, in an attempt to reduce maternal mortality caused by unsafe abortion. Three years later, I embarked on a trip to shoot a short documentary film on the impact that access to safe abortion care was already having on women in the country. The film was allowed to develop from an idea into a reality due to a genuine commitment to telling this story, and to being in the right place at the right time. During the Q&A after the screening of my short film Love, Labor, Loss (about a devastating maternal health injury called obstetric fistula) at the National Advocates for Pregnant Women Conference in 2006, an audience member asked what my next project would be. I responded that I wanted to make a film about unsafe abortion. Like obstetric fistula, it was an invisible problem, and few video resources were available. There needed to be a “face” put to the issue. An executive vice president of Ipas1, Anu Kumar happened to be in the room and she later said to me, “If you want to make a film about unsafe abortions, I’ll make sure you make a film about unsafe abortions.” And that’s when my film Not Yet Rain was born.

Leading the Region in Reproductive Health Policy

The decision to shoot the film in Ethiopia—rather than in any of the other countries in sub-Saharan Africa that suffer from high rates of maternal death and disability from botched and/or self-induced abortions—was A global nongovernmental organization dedicated to ending preventable deaths and disabilities from unsafe abortion


Above: Filmmaker Lisa Russell with Tegest, who lost her 17-year-old daughter due to an unsafe abortion procedure. Photo: Bekah Dinnerstein Right: Maternity clinic in Port Loko, Sierra Leone


December 2015 — Population Connection 31

Left: Sesay Tefare, a nurse midwife at Ziway Health Center, uses manual vacuum aspiration (MVA) to terminate first trimester pregnancies at the clinic level. Opposite: Belynash and Tigist received safe abortions thanks to a change in Ethiopian legislation.

Saba, I was introduced to the health care workers and various advocates who had already been informed about my mission. After learning more about the specific purpose of the film, the clinicians and health care advocates spoke to current patients and family members of patients who had died, asking if they would be interested in telling their stories for the film. Although I have covered many difficult global health issues, such as obstetric and traumatic fistula, the impact of war on youth, and AIDS orphans, this shoot quickly became the most emotionally difficult one I have ever done in my career.

Lasting Despair

The first person I interviewed was an elderly woman dressed in red. She told me the heartbreaking story of her daughter’s completely preventable death. She knew her daughter was sick with a headache and fever, but had no idea that a traditional medicine man had wrapped a catheter around an umbrella and put it into her daughter’s uterus to end her unwanted pregnancy.

based on Ethiopia’s recent change in legislation. Prior to the 2004 law, a woman who received an abortion was at risk of incurring criminal charges. Under this new law, a woman could seek a legal abortion if she was a minor, if she was raped, and if her life was in danger. This was a very radical move for an African country. So, after several months of planning, I departed to the capital, Addis Ababa, with my assistant (a 19-year-old spoken-word poet named Bekah, whom I mentor as a teaching artist). We set out for nearly three weeks, ready to film testimonials of the women, families, and health care workers who were affected by this new law. Working with Saba Kidanemariam, the incredible country director of Ipas Ethiopia, we quickly created a production plan that included shoots around the capital as well as a site visit to Ziway, a small lakeside town 100 miles south of Addis. Through 32 Population Connection — December 2015

The woman was solemn and stoic as she began to speak about her daughter, who was only 17 years old when she died from her unsafe abortion. Recounting the traumatic story, though, the mother began weeping and talking about the guilt she suffered over her daughter feeling like she couldn’t confide to her that she was pregnant or that she had sought an unsafe abortion. Had she known the truth, she could have informed a health worker and her daughter may have survived. But instead, this frantic mother took her daughter from clinic to clinic where no one could identify the root cause of her sickness. When they arrived at the final clinic, the daughter finally came forward with the truth. But by then it was too late to save her. “You are reminding me of something I have forgotten,” the elderly woman said as tears ran down her face. Although this happened 14 years before I interviewed her, it felt as if she were telling the story for the first time.

Lifesaving Care

I didn’t meet the two young women—Tigist and her friend Belynash—who would become the focus of my film until four days before I was supposed to leave Ethiopia.


December 2015 — Population Connection 33

Both young women had been raped and were pregnant; neither understood what pregnancy was, exactly, or how it had started. They heard about a procedure to stop pregnancy and came to the clinic to seek services. As I was filming, the girls were told by clinic staff that they had arrived too late—they were too far into their pregnancies for the first trimester abortion procedures that the clinic was prepared to perform. We all knew that unless they were able to get safe surgical abortions, they would resort to unsafe methods that can include

34 Population Connection — December 2015

inserting sticks and other sharp objects into the uterus, and drinking dangerous herbal concoctions. In an effort to get them the safest services possible, the clinic referred them to the Adama Hospital, the larger regional hospital, where doctors had access to pain medication and equipment more advanced than what was available at the local clinic level. Both Tigist and Belynash were terrified at the hospital, given that they had never even had a gynecological exam. They were especially shy knowing the exam would be done by a male OB/GYN, with his medical students observing.

Left: Lisa Russell (filmmaker) and Bekah Dinnerstein (poet) with members of a community in rural Ethiopia. Photo: Asnakecth Hundie Right: Ayanos Taye, a nurse midwife at the Ziway Health Clinic, believes that free, safe abortion care is important, particularly for poor women, and that it can save their lives.

When the doctor started to evaluate Tigist, she cried and screamed. My translator, Asnaketch, who had become a motherly figure to the two girls, tried to console her. It was there that Tigist told us she was afraid to die in childbirth as her mother had. Asnaketch did her best to comfort her, but at one point nearly fainted from the intensity of the experience. Bearing witness to all of this was a surreal experience. I became incredibly angry. Angry that rape is so prevalent everywhere. Angry that so many young women like Tigist lose their mothers in childbirth. Angry that girls don’t have the information about www.popconnect.org

family planning and contraception that could prevent unwanted pregnancies. Angry that safe abortion isn’t provided for any and all women in need. Angry that the world can be so incredibly cruel to young girls. I was so angry I nearly punched a wall.

The Aftermath

When I came home and began to edit the film, all those emotions were directed into the telling of the story. Although it was hard to watch the footage from this shoot for 7-8 hours at a

December 2015 — Population Connection 35

time, every day, the film came together in a powerful way that showed the challenges women face. But it also demonstrated their resiliency. The film had a very broad reach; it was screened by universities and communitybased organizations, shown at global health conferences, and even used as a tool for the African Union (to foster discussion about the incredibly high maternal mortality rates in the Africa region). Possibly the most surprising response I received was an email from a girl in the Middle East who lived in a country where abortion was illegal. She told me she and her boyfriend had watched the film and had decided that they were going to save up enough money to travel to Ethiopia for a safe abortion. She wanted to know if I could make a recommendation to a health care facility there. I was floored, and I passed her request on to someone who could give appropriate advice to her. Clearly, this film had a wider reach than I could have imagined. Since the Ethiopian shoot, I have filmed several interviews with women who resorted to unsafe abortion in Sierra Leone. While the women I interviewed in Ethiopia relied mostly on sticks and herbs for self-induced abortions, the women in Freetown, Sierra Leone, relied on the help of “pharmacists.” One woman told me that a popular method to terminate an unwanted pregnancy was to take 50 tablets of doxycycline, a malaria preventative, at 2:00 a.m. with a full can of Coke. Another popular method they told me about was drinking a local blue laundry detergent. This, the women were told, would end their pregnancies safely. Each country may have its own potion or procedure to self-induce an abortion, but they all lead to the same gruesome results: death, disability, and despair. Not Yet Rain ended up being more than an advocacy film for safe abortion care. It was a critical resource for women who faced unwanted pregnancies in restrictive areas. In this sense, the film became a lifeline to women and girls in need of unbiased, nonjudgmental reproductive health care and advice. I am proud to have my name on such a film as its director. Lisa Russell, MPH, is an Emmy® Award-winning documentary filmmaker and global health advocate who has more than 10 years’ experience producing films and creative projects/outreach campaigns with UN/NGO agencies. Since completing her Masters in Public Health (MPH) in 1998, and then learning the craft of filmmaking, Lisa has become a leader in bridging documentary filmmaking with global development and social activism and has an extensive portfolio of work that spans the globe.

36 Population Connection — December 2015

A security guard who survived seven self-induced abortions now refers victims of abuse and women with unwanted pregnancies to local health services.

“Thunder is not yet rain.” – African proverb


December 2015 — Population Connection 37

Washington View

Year in Review

2015 Chock Full of Attacks on Choice By Stacie Murphy


t’s fitting that this issue of our magazine is about abortion. It seems like that’s all 2015 has been about, too. It’s depressing to realize that even though there’s a general sense that Congress doesn’t actually do anything, there was a new attack or piece of bad legislation (or thwarting of good legislation) related to abortion or family planning every single month of 2015 so far. Don’t believe me? Just keep reading. January: Only days after being sworn in, House leadership, seeking to make a symbolic statement in response to the January 22nd anniversary of Roe v. Wade, brought H.R. 7, the “No Taxpayer Funding for Abortion Act,” up for a vote. Current law already prohibits federal funding for nearly all abortions, but H.R. 7 is intended to further limit access by imposing tax penalties on individuals who want to use their personal insurance or Health Savings Accounts to pay for terminations. The bill passed 242-179. H.R. 7 wasn’t actually the bill they originally wanted to pass. The plan had been to hold a highly publicized vote on a 20-week abortion ban. However, a number of female Republican legislators objected to the draconian requirements the bill would have imposed on rape victims. They objected not to the substance

38 Population Connection — December 2015

of the bill, but to the possibility that those requirements might damage the standing of the Republican party. February: On February 4th, Sen. Jeanne Shaheen (D-NH) and Rep. Jackie Speier (D-CA) jointly reintroduced the “Access to Contraception for Women Servicemembers and Dependents Act” (S. 358/H.R. 742). The bill would guarantee women serving in the Armed Forces and their dependents the same insurance coverage of birth control as their civilian counterparts. The bill was referred to the relevant subcommittees but has not been allowed to move forward. March: The previously bipartisan “Justice for Victims of Trafficking Act of 2015” (S. 178/H.R. 296) suddenly became contentious when Democrats in the Senate discovered an anti-abortion provision hidden in the bill. The language would have extended the Hyde amendment, which bars the use of taxpayer funds for most abortion care, to funds set aside to help victims of trafficking. After more than a month of negotiations, the sides compromised by splitting the money into two funds, neither of which will be used for abortions. Several senators recognized the bill’s limitations, yet decided it was worth supporting anyway. The final version of the bill became law in May.

April: On April 30th, the House voted 228-192 to express its disapproval of a new law passed by the District of Columbia. The “Reproductive Health Non-Discrimination Act,” passed by the D.C. City Council in December 2014, forbids employers from discriminating against their employees based on “use or intended use of contraception or fertility control or the planned or intended initiation or termination of a pregnancy.” House Republicans said they believed the bill to be an unconstitutional violation of the religious rights of employers. May: On May 13th, the House finally got around to voting on the 20-week abortion ban they had previously considered in January. After tweaking some language about the requirements for rape victims, the bill passed 242-184. It imposes mandatory waiting periods, even on rape survivors, and contains no exceptions for severe fetal malformations or to protect women’s health. June: The House Appropriations Committee passed the FY 2016 State Department and Foreign Operations Appropriations bill on June 11th. It slashed funding for international family planning by $150 million, barred any U.S. contribution to UNFPA, and reinstated the Global Gag Rule.

July: On July 14th, an anti-choice group released the first of several heavily edited, deeply dishonest videos shot by an “undercover” operative in an attempt to smear Planned Parenthood. The group alleges that these recordings prove that Planned Parenthood is illegally selling body parts from aborted fetuses. Although the videos show no such thing, Republican presidential candidates immediately leapt to prove their bona fides by condemning the organization, and anti-choice members of Congress began introducing competing pieces of legislation to end Planned Parenthood’s federal funding (which doesn’t cover abortion services anyway). August: After sorting through all the bills introduced to defund Planned Parenthood, the Senate settled on a measure sponsored by Sen. Joni Ernst (R-IA). On August 3rd, just before leaving for their summer recess, the Senate voted on her bill. After many dramatic speeches, the bill failed to achieve the 60 votes necessary for cloture in the Senate (53-46). In a procedural move to allow him to reintroduce the bill later, Majority Leader Mitch McConnell (R-KY) switched his vote from “Yes” to “No.” September: The right-wing furor over funding for Planned Parenthood was www.popconnect.org

still going strong, leading to a busy month on the Hill. On September 9th, the House Judiciary Committee held a hearing with the neutral and unbiased <sarcasm> title “Planned Parenthood Exposed: Examining the Horrific Abortion Practices at the Nation’s Largest Abortion Provider.” No one from Planned Parenthood was invited to speak. Later that month, on the 29th, although Planned Parenthood’s president, Cecile Richards, was the sole witness at yet another House hearing, she still didn’t get much of a chance to talk. Instead, she was repeatedly interrupted by hostile committee members. Additionally, on September 18th the House voted 241-187 to strip Planned Parenthood’s federal funding, although they knew the bill could not pass in the Senate. With the fiscal year ending on September 30th and several ultra-conservative members threatening to shut down the government over the issue, the Senate held two votes designed to placate these members. On September 22nd, the Senate attempted to pass the 20-week abortion ban previously approved by the House. The bill failed to reach the 60-vote threshold and was rejected. Finally, on September 24th, they attempted to pass a measure to fund the government while

excluding Planned Parenthood funding. That measure failed, 47-52. October: On October 23rd, the House voted on yet another bill targeting federal funding for Planned Parenthood. The largely symbolic measure also attempted to dismantle key portions of the Affordable Care Act. After passing in the House, 240-189, the measure is not expected to reach the Senate floor. The same day as the vote, House leadership also announced the names of the eight Republican appointees to a new House group tasked with “investigating” abortion practices and procedures in the United States. Chairwoman Marsha Blackburn (R-TN) stated that “[t]his is not about Planned Parenthood. This is about abortion service providers and medical practices and tissue procurement organizations and the relationships between them, so it is broader. It’s going to focus on the industry at large.” She also insisted that the goals of the panel, which she calls “The Select Investigative Panel on Infant Lives” are not political. This trend is sure to continue through November and December and into 2016, but our print deadline is too soon to include those months. Be sure to check our website for the latest news! December 2015 — Population Connection 39

Field & Outreach

Women Urgently Need Safe Abortion Services in Africa By Rebecca Harrington and Karen Hampanda, MPH


he field team has been crisscrossing the country this fall, making stops at campuses and communities to talk with hundreds of individuals who are committed to expanding access to reproductive health care for women around the globe. In mid-September, we traveled to Columbus, Ohio, to host a screening of the documentary film Vessel, which chronicles the journey of Rebecca Gomperts, a Dutch abortion doctor and activist, and her mission to provide abortion services to women who live in countries where the procedure is illegal or heavily restricted. Dr. Gomperts is the founder of the organizations Women on Waves, which provides medication abortion to women on a ship in international waters, and Women on Web, a website that provides instructions for using medication abortion and a mail order service for prescribing and ordering the pills. Over 60 people—ranging from college students to middle-aged activists— joined us at the Gateway Film Center, a non-profit theater near Ohio State’s campus, for a rich discussion about the state of reproductive rights here in the United States and abroad. We organized 40 Population Connection — December 2015

the event with Columbus arts and reproductive rights activists. According to Amanda Patton, one of the event organizers, “The Vessel screening was wonderful—the group of attendees were very enthusiastic and the reception afterwards was a great opportunity to network with women from all walks of life.”

Not Yet Rain Panel

In October, we joined Karen Hampanda, a PhD candidate at the University of Colorado Denver, and Jordan Rief, an independent researcher at Emory University, on a panel organized by the Center on Rights Development at the University of Denver. We screened the documentary film Not Yet Rain, and each panelist shared her response to the film. Not Yet Rain, directed by Lisa Russell (the author of the article that begins on page 30 of this issue), shares the stories of women struggling to access abortion care in Ethiopia, before and after the country liberalized its abortion law in 2004. During the presentations, and the thoughtful discussion that followed, panelists and audience members discussed how the denial of safe abortion care for rape survivors victimizes them a

second time; how the political struggle around abortion in the United States affects low-income American women and women who live in countries that receive U.S. aid; and how outrageous it is that unsafe abortion in the developing world kills 47,000 women each year. As a follow-up to our work together on the panel, I asked Karen to write a short piece sharing her reflections from her public health work in Zambia.

Karen Hampanda on Abortion in Sub-Saharan Africa

Due to restrictive abortion laws and a lack of trained providers, more than 97 percent of abortions received by African women are unsafe. Up to 5 million unsafe abortions are performed in the region every year, and 1.7 million women are hospitalized annually for complications arising from those procedures. Ironically, the abortion laws governing African countries are remnants from the colonial era, imposed by European countries that long ago abandoned such restrictive laws for themselves. In 14 African countries1, abortion is not Angola, Central African Republic, CongoBrazzaville, Democratic Republic of the Congo, Egypt, Gabon, Guinea-Bissau, Lesotho, Madagascar, Mauritania, Mauritius, São Tomé and Principe, Senegal, and Somalia


permitted for any reason, including to save the woman’s life or in cases of rape or incest. Of course, when abortion is illegal, women simply resort to unsafe methods to terminate pregnancies, such as inserting chemicals/herbs into the vagina, attempting to puncture the fetus with objects through the cervix, and ingesting toxic chemicals. My public health work in Zambia over the past six years has provided me with a unique perspective on this issue. Zambia actually has one of the most liberal abortion laws in sub-Saharan Africa—abortion is permitted to save the woman’s life, to preserve physical health, to preserve mental health, and on socioeconomic grounds. Unfortunately, however, this does not always translate into real access. In Zambia, a woman must first get the approval of three physicians before she can go to one of the few facilities that perform abortions. (Keep in mind that there are fewer than two physicians per 10,000 people in Zambia.) As a result of this and other barriers, women who find themselves with an unwanted pregnancy often resort to self-induced abortions. One common method in Zambia is to swallow large www.popconnect.org

amounts of an anti-malarial medication called chloroquine. Chloroquine may end a pregnancy; however, overdose of this medication may also cause convulsions, coma, cardiac arrest, and even death. In addition, such restrictive abortion policies result in health disparities by socioeconomic status within countries. In countries with restrictive laws, wealthier women can often pay to find a qualified provider willing to perform an abortion; however, the vast majority of women in Africa are too poor to benefit from such underground networks. For example, in Uganda, where 97 percent of the population lives on less than $2 a day, the price of an abortion from a professional health care provider ranges from $6–$58. Only three countries (Cape Verde, South Africa, and Tunisia) have laws that allow induced abortion for any reason—laws that have had a hugely positive public health impact. In 1997, South Africa made abortion legal for any reason and available on request. In the years after this policy shift, abortion-related deaths dropped by over 90 percent. A newer example is that of Ethiopia. After the law was liberalized in 2004,

abortion complications per 100,000 live births at one large hospital decreased by about 70 percent. The deaths and injuries that result from unsafe abortions are entirely preventable through two key measures: increasing access to modern family planning and improving access to safe abortions. Currently, there is no method of birth control that is 100 percent effective (excluding abstinence), and few people use birth control perfectly. Furthermore, 1 in 5 women globally suffer rape or attempted rape in their lifetime. I frequently see reports discussing access to safe abortion within the limits of existing law; although this is a critical immediate goal, a longer-term, more impactful goal would be to instigate policy changes surrounding restrictive abortion laws. Karen Hampanda is a Doctoral Candidate and National Institute of Mental Health (NIMH) Pre-doctoral Fellow in the Department of Health and Behavioral Sciences at the University of Colorado Denver. She is also an adjunct professor at the University of Colorado Denver and the University of Denver, teaching courses in Gender and Health and Human Sexuality and Public Health. December 2015 — Population Connection 41

An October Road Trip with PopEd PopEd

By PopEd Staff


ur staff and volunteer trainers facilitate teacher workshops year-round, but October is, by far, our busiest month. Of the more than 150 workshops we presented in October, 70 were facilitated by our staff, who traversed the United States and eastern Canada. Here’s just a sampling of those experiences.

Lindsey Bailey, Teacher Training Manager

A quiet group of future science teachers at the University of Ottawa were suddenly talking over each other with remarks like, “Yes, that’s happening here!” and, “It’s just like that farm!” The activity that drew them out of their shells was “Earth, the Apple of Our Eye,” a powerful visual lesson using an apple to represent the planet. After setting aside pieces of the apple to represent water, inhospitable regions (poles, deserts, mountains), and developed land, students see that only 1/32 of the earth is arable land capable of growing food. After gaping at the tiny remaining piece of apple, we discussed over-farming, erosion, and pollution. But it wasn’t until a student pointed out the impact of urban sprawl that the light bulbs went off. A portion of a farm just a few miles from campus is in jeopardy of being lost to 42 Population Connection — December 2015

sprawl, they told me. Founded on the outskirts of the city in the 1880s, the Central Experimental Farm now sits within the city’s downtown. It is the federal research site for the Canadian Department of Agriculture, which has gained international recognition for its soil preservation and agricultural research. Losing this farm would not only mean losing land, but would also end years of soil studies. After discussing the farm, it was clear that the students could see the relevance of population issues in their everyday lives.

Education program. When faculty members see the value of PopEd resources and the impact of our hands-on workshops, they ask us back again and again.

Carol Bliese, Director of Teacher Programs

Haskell is one of 32 fully accredited Tribal Colleges and Universities in the United States, serving over 1,000 students representing 140 Tribal and Alaska Native communities. While the university’s roots have ties to a dark chapter of our nation’s history (it was founded in 1884 as an elementary school aimed at assimilating American Indian children into the Protestant “mainstream”), its success since becoming a junior college 45 years ago is tangible evidence of the relentless selfdetermination of Tribal communities.

While in southern Florida, I presented workshops to five sections of the elementary science methods course at Florida International University in Miami—one of the largest universities in the United States, with 55,000 students. Though the first PopEd workshop at FIU was back in 1999, we have not had a consistent presence on the campus since the mid-2000s. But hopefully that is about to change. I have already begun discussing PopEd workshops for science classes next spring with the professor who organized my fall workshops. Building relationships with university education faculty is key to the longterm sustainability of the Population

Lauren Boucher, In-Service Coordinator

One of my favorite things about traveling with PopEd is experiencing a diversity of backgrounds, cultures, and ideologies. On a recent trip to the Midwest, I was particularly struck by a small group of students I worked with at Haskell Indian Nations University in Lawrence, Kansas.

After the workshop, students shared information about their upbringings and their future careers as teachers. Many want to work in schools on reservations in order to close the widening achievement gap. I was very inspired by these students and their strong convictions.

They really saw the utility of the PopEd curriculum and were excited to incorporate our lessons into their classrooms.

Lauren Carlson, Curriculum Resource Coordinator

A trip through southern New England brought me close to colorful fall foliage and enthusiastic student teachers. My first workshop of the week was for graduate students in a social studies methods course at Regis College, outside of Boston. We started the workshop by watching the World Population “dot” video and creating population pyramids for six different countries. This stimulated a great discussion on population projections and which countries are growing faster than others. Then, a student asked about refugees and internally displaced populations—how and where those people are counted now and in the

PopEd Workshop Locations in October


future, and how population pyramids might change because of that. That unexpected deviation was memorable for me as a facilitator because, while we didn’t get through our entire planned agenda, we had an interesting and relevant discussion, and all the workshop participants were engaged in the material. We were able to take the curriculum and root it in real-world events, and those students walked away that evening excited to teach!

Isabelle Rios, Education Program Associate

A recent trip to North Carolina took me from one beautiful campus to another. At the University of North Carolina in Greensboro, I spent a full day working with elementary social studies teachers on topics ranging from land use and

water pollution to global economics. I was particularly impressed by reactions and thoughts elicited by the activity “Global Cents,” in which students develop budgets to meet the basic needs of average American and Malawian families. They thoughtfully considered their needs and wants and how to make both work within two very different budgets and lifestyles. This lesson really resonated with several students, stimulating ideas on adapting this activity to raise student awareness about the social and economic gaps that persist in our own country. It is so powerful to see a group of young educators understand and appreciate the potential that each of our activities has, and even more exciting to hear them articulate how they are going to adapt them to make a lasting impact on their students.

Lauren Boucher (third from the left) with student teachers at Haskell Indian Nations University

December 2015 — Population Connection 43


44 Population Connection â&#x20AC;&#x201D; December 2015

Editorial Excerpts

Washington, D.C.

McLean, Virginia

Enacted in 1973, the Helms amendment stipulates that foreign assistance may not 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.” It is clear that abortions to end pregnancies caused by rape are not barred by that language. But successive administrations, Democratic and Republican, have treated the amendment as an absolute ban on funding any abortions. That interpretation has forced survivors to have the children of those who raped them—with all the attendant anguish, health problems, and societal-acceptance issues—or seek out their own methods to end the pregnancies. Each year too many women around the world die from unsafe abortions.

A constitutional right that’s almost impossible to exercise isn’t much of a right at all. Yet the right to an abortion—guaranteed 42 years ago by the U.S. Supreme Court—has been saddled with so many onerous strictures in so many states that for millions of women, it has become almost meaningless.

At one camp for Nigerians displaced by Boko Haram that was visited by the [New York] Times, more than 200 women were found to be pregnant but relief officials said they believed the number of those bearing the unwanted children of militants to be far higher. “The sect leaders make a very conscious effort to impregnate the women,” a local official told the Times. “Some of them, I was told, even pray before mating, offering supplications for God to make the products of what they are doing become children that will inherit their ideology.” President Obama has spoken movingly about the “mothers, sisters, and daughters” subjected to rape as a weapon of war, but he has failed to follow through with needed action. A growing roster of religious leaders and human rights and women’s health groups have called upon him to take executive action to clarify that the Helms amendment does not apply in cases of rape or incest or when a woman’s life is endangered.

Since 2010, abortion opponents have passed more than 280 restrictive laws, mostly in the South and across the middle of the country. More restrictions are on the way, as legislatures return to work this fall. Virtually all of them substitute government mandates for a woman’s freedom to choose. In 1992, the Supreme Court opened the door to some state restrictions on abortion … as long as restrictions did not place an “undue burden” on a woman’s rights. Abortion opponents, unable to overturn Roe v. Wade, have used that opening to chip away at abortion rights with increasingly burdensome regulations. While some federal courts have rejected extreme laws, too many judges have let opponents get away with them. “Undue burden” might be hard to define. But the justices ought to know it when they see it, as Justice Potter Stewart famously said of pornography. Women should not have to wait days, listen to forced lectures, drive hundreds of miles, or do battle in court repeatedly to access a right guaranteed long ago by the highest court in the land. —September 7, 2015

We hope Mr. Obama gets the message and takes the steps needed to ease the suffering of war rape victims by giving them access to the medical care that is their right. —May 29, 2015


December 2015 — Population Connection 45

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