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Population Connection Volume 48, Issue 2 June 2016

ZIKA VIRUS CASTS SPOTLIGHT ON

REPRODUCTIVE RIGHTS

IN LATIN AMERICA


President’s Note

W

e’ve all heard it. The high-pitched whine signaling that a mosquito is looking for a meal. For most of us, it’s just an annoyance. In warmer climes, it’s quite a different matter. Imagine the terror of a woman infected with the mosquitoborne Zika virus who discovers she is pregnant. If ever there was a time to smash any and all barriers to contraception and safe abortion, that moment is now. Yet, millions of women in Latin America and the Caribbean still have an unmet need for family planning. And in several countries where Zika is active (the Dominican Republic, El Salvador, Haiti, Honduras, Nicaragua, and Suriname), abortion is always a crime, often punishable by life imprisonment. Even in countries where abortion is legal in cases of rape, incest, or threats to the life or health of the woman, U.S. aid has been blocked due to a gross misreading of a nearly 50-year-old law, the Helms Amendment. President Obama could fix Helms with the stroke of a pen. Yet, even though we’ve delivered 700,000 citizen petitions to the White House, he has inexplicably refused to do so. The good news is that we have secured firm commitments from both Secretary Clinton and Senator Sanders to fix Helms after taking the presidential oath of office. None of the GOP candidates has seen fit to make a similar commitment. Many of us take family planning for granted in our personal lives. It’s akin to dental hygiene or proper footwear. Yet it remains a revolutionary idea in so many places. And where a single hungry and Zika-infected Aedes mosquito can result in microcephaly and other horrific outcomes, women need to be able to make their own informed decisions about whether to continue their pregnancies after becoming infected.

Population Connection — June 2016

It all seems so obvious and reasonable, doesn’t it? Yet there are powerful forces working day and night to roll back progress. A leading Brazilian Catholic bishop made it clear that facts don’t matter, nor do women’s lives: “Contraceptives are not a solution. There is not a single change in the church’s position.” Here at home and abroad, zealots are hellbent on blocking access to contraception, so women have no choice but to become pregnant. They want to strip women of their right to privacy regarding decisions about the continuation or termination of their own pregnancies. This is not acceptable. So, we’ll keep fighting to rein in and repeal the Helms Amendment for as long as it takes. As population continues to soar, pandemics could devastate hundreds of millions of people. A leading infectious disease expert, Dr. Amy Vittor, explains that, “People living in crowded circumstances, a lack of piped water, and poor sanitation, have given rise to the perfect set of conditions for the transmission of mosquito-borne viruses like Zika.” More than 100 million people live in slums throughout Latin America. Brazil has a slum population of 50 million. Rio de Janeiro alone has more than 1,000 favelas. Pathogens don’t respect borders. Ending population growth would make for a safer world. As health experts battle the Zika virus, the 1966 words of Dr. Martin Luther King, Jr. ring true: “Unlike plagues of the dark ages or contemporary diseases we do not yet understand, the modern plague of overpopulation is soluble by means we have discovered and with resources we possess.” The entire world will benefit if we heed King’s call.

John Seager john@popconnect.org


Population Connection Volume 48, Issue 2 June 2016

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 Editor Marian Starkey marian@popconnect.org Authors Alexandra Behette, Whitney Eulich, Uri Friedman, Jennifer Lynaugh, Stacie Murphy, Catherine Osborn, John Seager, Marian Starkey, Pamela Wasserman

Features 10

A Country Without Babies

By Uri Friedman

16 In Latin America, an Exception to Falling Birth Rates Draws New Scrutiny

By Whitney Eulich, Correspondent, and Catherine Osborn, Contributor

Departments

Proofreader Skye Adams

2

Editor’s Note

Population Connection (ISSN 2331-0529)

3

Letters to the Editor

4

Pop Facts

6

In the News

8

From Our Members

26

Washington View

28

Field & Outreach

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 Tzotzil woman with her child in Zinacantan, Mexico. © Arturo Sanabria, Courtesy of Photoshare

www.popconnect.org

30 PopEd 32

Book Announcement: The Good Crisis is Available Now!

33

Editorial Excerpts

June 2016 — Population Connection

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Editor’s Note

I

magine being in your prime reproductive years, settled down with a partner, and ready to start a family, and then being asked by your federal government to hold off on getting pregnant for two years. Or being at the end of your reproductive years and knowing that if you wait two more years to get pregnant you might never get pregnant at all. Now imagine becoming pregnant by accident, either through misuse or nonuse of birth control, contraceptive failure, or rape. You’ve been asked to hold off on getting pregnant for two years as well, but here you are, pregnant anyway. You can’t get a safe abortion because the procedure is illegal or highly restricted in the country where you live (see our Pop Facts graphic on page 4). So you continue your pregnancy and hope that you don’t become infected with the Zika virus that’s spreading all around you. When you do become infected, you pray that your developing fetus doesn’t suffer birth defects. Or, you find someone to perform an illegal, unsafe abortion (95 percent of abortions performed in Latin America are unsafe). This series of grim hypothetical scenarios is the miserable reality for women in several Latin American countries that are scrambling to deal with the spread of Zika, which has been linked to severe microcephaly in the babies of mothers infected with the virus during pregnancy. Their governments don’t want them to get pregnant, and won’t allow them to have abortions if they do, but they also won’t broaden access to modern contraception because some highranking Catholic bishops say it’s against the rules. Perhaps these bishops and bishop-fearing government officials have forgotten that women can’t become pregnant on their own. That women alone are not responsible for unintended pregnancies or pregnancies that are very much wanted but might be detrimental to the developing fetus. Perhaps celibate men

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Population Connection — June 2016

shouldn’t be making sexual health decisions for women at all. Perhaps, and yet … One organization that is determined to help expand reproductive rights in Zika-affected countries (and anywhere else abortion is illegal) is Women on Web. The mission of the Dutch non-profit is to provide medical abortion (which is only effective very early in pregnancy) to women in countries where it is illegal. It does that by fulfilling orders for the pills online and shipping them to the consumers directly. Of course, these pills are often confiscated by customs, but some do make it all the way to their intended recipients. Back in February, Women on Web reported that since the Zika virus first started spreading, in May 2015, orders for the pills had spiked by 25 percent in Brazil, the country where the Latin American outbreak began. Haiti and Guatemala are the only two Latin American countries with Zika transmission that still receive U.S. foreign aid for family planning and reproductive health, because of our policy of “graduating” countries whose fertility rates have dropped below 3.0 children per woman. However, as the article on page 16 discusses, fertility rates within countries often vary widely, between women urban and rural, rich and poor, and educated and unschooled. Many family planning program experts lament these graduations as they prematurely remove funding that is still critically needed among vulnerable sectors of the population. The 150 million women of reproductive age in Latin America are living in fear of bringing a child into this world only to suffer. We must do everything we can as a donor country to alleviate that fear through improved access to comprehensive, voluntary family planning services and supplies for all.

Marian Starkey marian@popconnect.org


Letters to the Editor

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 .

Thanks for the informative issue on the status of contraception and population in Ethiopia in particular and Africa in general. I have long wondered why vasectomy was not emphasized more in population and health discussions. Good to know it’s easy to obtain in Ethiopia at least. On a more general note, I believe a safe and effective male contraceptive pill could change population dynamics far more cheaply and quickly than the current emphasis on female contraception. Of course, it would take a concerted and consistent health services campaign to sway male egos and fears, but the effort might save the planet. Larry D. Little Stone Mountain, Georgia I recently received information and solicitation for donations to your organization in the mail, and am certainly a supporter of your mission. However, I searched your FAQ and other aspects of the website for information on the availability and effectiveness of contraception for men, and found almost nothing except for a brief mention about the use of condoms. Have I missed something? Why is this huge responsibility still left almost entirely to women? What is your organization doing to educate men and help to develop contraception for men that is more effective than condoms and less invasive than surgery? Kathy Darrow Phoenix, Arizona It would be wonderful if there were an effective, reversible method of birth control for men besides condoms. It seems like we’re always a couple of years away from a pill or injection for men that would temporarily suspend their fertility (Vasalgel—which has been shown to work on rabbits—is headed for clinical trials with humans this year, and researchers say it could be available as early as 2018). Population Connection works to increase funding for contraceptive research, and if a new method were to be developed and made available to consumers, we would fully support its availability without www.popconnect.org

Attn: Marian St Population Co

arkey

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

copay in the United States and its inclusion in the package of services that our country’s foreign aid funds overseas. The last two issues were excellent, but especially the one on Burundi. I passed my first copy on to my brother, who has spent time there. I wish I knew where else to leave your excellent magazine once I’m done reading it. Maybe my doctor’s office? Yesterday, I slipped the one on the Helms Amendment into the magazine rack at my local gym. I hope someone who needs to see it gets a chance to do so before the managers there throw it out as too controversial. Sigh. Lois Braun St. Paul, Minnesota For several years I have been hearing the voices of panic over birth rates being “too low,” so I was interested in the March 2016 issue of Population Connection magazine. I was disappointed in the article because it seemed to me that the solutions proposed were short term, being dependent on continued human population expansion in some areas of the world to support areas where growth has been limited. I have to think that if humans believe there’s a techno answer for every problem facing culture and the planet, they should have a techno and policy answer to any perceived “shortage” of humans. It will be up to population advocates to develop strategies to deal with the social/financial/anthropocentric side effects of limiting human population growth. Mary Anne Hoover Ogden, Utah Please go back and read our staff columns from that issue, and you will see that we are fully in agreement. Also see the book announcement on page 32 of this issue—our first book explores policy and technology opportunities that low fertility presents to society and the planet! June 2016 — Population Connection

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www.popconnect.org

June 2016 — Population Connection

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In

the

News

Texas Medicaid Births Up Since Closure of Dozens of Planned Parenthood Clinics

affected by the exclusion and decreased in the rest of the state.”

A study published in March in The New England Journal of Medicine shows an alarming trend when it comes to access to the most effective forms of contraception and childbirth among poor women in Texas.

In summary, cutting off poor women’s access to highly effective contraception increases the rate of Medicaid births and cost to the state and federal governments. But we knew that already.

The study looked at data from the two years before and the two years after 82 family planning clinics—a third of them Planned Parenthood affiliates—in Texas were forced to close due to the elimination of federal grants. The women studied had incomes at or below 185 percent of the federal poverty level and relied on Medicaid for their healthcare coverage. They lived in one of the 23 counties (of the 254 counties in Texas) that had a Planned Parenthood clinic at the start of the study period. The clinic closures are correlated with a 31.1 percent reduction in Medicaid claims for injectable contraceptives, and with a 27.1 percent increase in the proportion of women who had childbirths covered by Medicaid within 18 months of receiving a contraceptive injection (which is only effective for three months). The study’s authors write, “Although data are lacking on intendedness of pregnancy, it is likely that many of these pregnancies were unintended, since the rates of childbirth among these women increased in the counties that were 6

Population Connection — June 2016

Asian American Teens Avoid Sex Talk with Doctors; Cite Confidentiality Fears A survey study published in the Journal of Adolescent Research found that Asian American teens are uncomfortable talking with healthcare professionals about sex and related topics, especially if those healthcare professionals are also Asian. The teens in the study, who all live in the Dallas area, said that they feared their doctors reporting to their parents what they said during their appointments and would therefore lie if confronted with the topic during an exam. Many of the study participants were unaware of doctor-patient confidentiality clauses and said that if they knew their comments would be confidential they would disclose more. The teens in the study said that people commonly believe that Asian teens aren’t engaging in sexual behavior, which makes it all the more uncomfortable to disclose. Age at first sex and STI prevalence for Asian teens, however, are the same as for white teens.

Teens Who Live Near Planned Parenthood Less Likely to Drop Out of High School A study published in April in the journal Obstetrics and Gynecology found that teenage girls who live near a Planned Parenthood clinic are 16 percent less likely to drop out of high school than those who do not. This makes plenty of sense, as 30 percent of female dropouts cite pregnancy and parenthood as key reasons for leaving school.

Unintended Pregnancies in U.S. Lowest in 30 Years Of the 6.1 million pregnancies among women ages 15-44 in the United States in 2011, 2.8 million were unintended. The rate—45 unintended pregnancies per 1,000 women of reproductive age— was the lowest it had been since 1981. The percentage of all pregnancies that were unintended declined from 51 percent to 45 percent from 2008 to 2011. The percentage of pregnancies among cohabiting (partnered, but unmarried) women that were unintended in 2011 was still high, at 81 percent. The research was published in The New England Journal of Medicine. The lead author of the report, Lawrence B. Finer, says, “The biggest change is women using some form of contraception, and a substantial shift toward the use of longacting methods.”


Medical Abortion Access in Maine Increases with Telemedicine Women in the largely rural state of Maine now have access to medical abortion via teleconference with a physician. Patients can visit any of Maine Family Planning’s 16 clinics throughout the state to be screened for eligibility. If medical staff determine that the patient can safely take the drugs that will terminate the pregnancy, the patient schedules a videoconference with a physician at one of the three clinics in the state where abortions are performed on site. The physician directs the patient to take the first medication, called Mifeprex, while she or he watches. The patient takes the second medication, Misoprostol, at home, 6-48 hours later. Patients are required to agree to have a support person nearby when they take the second medication at home. In order to qualify for a medical abortion, a woman must be no more than 70 days from the first day of her last period. Pregnancies that are farther along require a surgical procedure for termination (vacuum aspiration being the most common).

Study Finds Most Young Men Aren’t Aware of Emergency Contraception A new study found that most young men have never heard of emergency contraception. The computerized survey analyzed the responses of 93 young men www.popconnect.org

between the ages of 13 and 24 at the adolescent medicine clinic at Children’s Hospital in Aurora, Colorado, between August and October 2014. Most of those surveyed had been sexually active, but only 42 percent had heard of emergency contraception. Although the study sample size makes it difficult to generalize, the results do indicate that there is a need for increased education on the availability and proper use of emergency contraception, especially among young men who are sexually active and do not wish to impregnate their partners (84 percent of the survey participants said they believed avoiding a partner’s pregnancy was very or somewhat important).

Sting Operation Results in Ironic Indictment David Daleiden and Sandra Merritt— under the hidden auspices of the Center for Medical Progress, an organization Daleiden created in order to attack abortion providers—have been indicted on felony charges, in a most satisfying twist to their deceitful attack on Planned Parenthood. The coconspirators posed as biotechnology representatives to infiltrate Planned Parenthood and secretly record their efforts to purchase fetal tissue. The undercover videos were released, one by one, to the media in the summer of 2015. After initially being assigned to investigate the claim that Planned Parenthood

was breaking the law by “selling” fetal tissue, Harris County [Texas] District Attorney Devon Anderson (who herself is pro-life) charged Daleiden and Merritt with a felony for manufacturing and using fake California driver’s licenses for their meeting last year with the Planned Parenthood affiliate in Houston where the videos were filmed. They are also accused of setting up a phony company called Biomax Procurement Services and claiming to be a legitimate provider of fetal tissue to researchers. Their guerrilla efforts to shut down Planned Parenthood by bringing shame to the organization for its practice of donating fetal tissue for scientific research have resoundingly backfired. Planned Parenthood has been cleared of any wrongdoing and the real criminals may be heading to prison.

Average Age of First-Time Mothers Keeps Climbing in the United States In 2014, the age of first-time mothers in the United States had risen to 26.3, from 24.9 in 2000. The shift occurred in all states and across all racial and ethnic categories. A decrease in teen births is largely to thank for the upward shift. The proportion of first-time mothers younger than 20 years old dropped from 23 percent to 13 percent between 2000 and 2014. In 1970, the average age of first-time mothers was 21.4.

June 2016 — Population Connection

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FROM OUR MEMBERS:

Dr. Margery Nicolson, Scientist and Conservationist By Jennifer Lynaugh

U

pon meeting Dr. Margery Nicolson, what stands out is her clear love of nature and wildlife. Her enthusiasm for protecting our planet’s wild spaces takes priority in our conversation. Margery and her late husband, Iain, a native of Scotland, joined the movement to stabilize human population after reading Paul Ehrlich’s book The Population Bomb. Married for close to 40 years, she and Iain reveled in nature, backpacking, and exploring the Sierra Nevada mountains stretching across Central and Eastern California. “We enjoyed everything that the Sierras had to offer—birds, big trees, plant life, flowers, and serenity,” she says, “and we realized how important it was that this land be protected.” Much of the Sierra Nevada was still unprotected during this time, so she and Iain became avid advocates to defend the land against development. “I’m proud to say, with the involvement of many environmental groups, we did it!” she recalls. Growing up in Pasadena, California, Margery remembers playing in her family’s large backyard and developing

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Population Connection — June 2016

summer outdoor projects with friends and family. Her love for nature was further fostered by spending summers at her grandparents’ home in Carmel, California, where she learned to garden and hike. “I spent just about every waking minute outdoors,” she remarks. “The Monterey Peninsula was the stimulus for my love of nature.” Margery may have loved the outdoors, but she also loved academics, and she pursued her undergraduate and graduate degrees in Biological Sciences at Stanford University. When her PhD advisor moved to Baylor Medical School in Houston, Texas, she followed him there. She received her PhD in Biochemistry in 1960. She recalls, “I was a minority in the field, since there were very few female scientists in the U.S. in those days.” After teaching at the University of Southern California School of Medicine, lecturing and conducting research, she was recruited by Amgen, a global biotechnology firm,

as one of its first 30 scientists. “I loved research, so I went!”

Margery and her late husband, Iain, a native of Scotland, joined the movement to stabilize human population after reading Paul Ehrlich’s book The Population Bomb.

During her time at Amgen, she worked with a team of scientists to develop a compound called erythropoietin (EPO), a type of synthetic hormone used to treat patients with kidney disease, “filling a niche need in medicine,” she says. She remembers “working hard and playing hard” with her colleagues. She retired after 18 years, when Amgen’s ranks had ballooned to more than 16,000 people.


Since retiring, Margery has dedicated more of her time to traveling the world and advocating for the causes most near and dear to her. She has been a leading advocate for wildlife—especially birds, and, in particular, the Sandhill Crane. “The Iain Nicolson Center at Audubon’s Rowe Sanctuary—named after my husband—opened in 2004 in Nebraska. It’s a very simple, beautiful structure on the Platte River. During the month of March, the Sandhill Cranes fly through on their migration north in large numbers, sometimes 200,000 at a time. They spend three to four weeks fattening up on leftover corn found in the fields surrounding the center so that they can complete their six-week journey up to the Arctic, where they nest. It’s a really spectacular sight, and every year I spend two to four weeks acting as a volunteer guide for the 18,000 visitors who come to see the cranes. It’s a March highlight for me!” She’s pragmatic in her outlook on population, saying, “We need to figure out a better way to stabilize population. Education must be the basis. Without www.popconnect.org

education and awareness around the issue of population growth, nothing will happen and habitats will continue to be reduced.” With her generous support of Population Connection, Margery is investing her own pioneering spirit in the next generation of population advocates. We applaud her commitment to the preservation of nature and her dedication to raising awareness about the impact of population growth on our environment. Thank you, Margery, for serving as an inspiration to us all!

“We need to figure out a better way to stabilize population. Education must be the basis. Without education and awareness around the issue of population growth, nothing will happen and habitats will continue to be reduced.”

If you would like to become a member of the President’s Circle, please contact Jennifer Lynaugh, Development Officer, at jennifer@popconnect.org or (202) 974-7710.

June 2016 — Population Connection

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Article Title Article Author

Both photos this page: Patients flock to a mobile clinic organized by Yale University students in Tegucigalpa, Honduras. Š Damian Weikum/Yale University, Courtesy of Photoshare

10 Population Connection — June 2016


A Country Without Babies

Governments are telling women to postpone pregnancy during the Zika outbreak. What happens if they do? By Uri Friedman Originally published by The Atlantic

T

he rapid spread of the Zika virus across Latin America, and its suspected link to an outbreak of birth defects, has prompted governments to do something without much precedent in human history: urge people to hold off on having kids. Facing what the World Health Organization has now called an international emergency, El Salvador has asked women to avoid getting pregnant until 2018, while countries such as Brazil and Colombia have suggested waiting several months, or indefinitely. Imagine you are trying to get pregnant, or already are, and you hear that message from your government. Would you take it seriously? And if you did, and all your peers did, what would that actually look like five, or 25, years out? Classes with no or hardly any students? Baby stores forced out of business? A depleted younger generation unable to support older ones?

www.popconnect.org

What, in other words, are the social and economic consequences of a gap like that in a country’s or region’s population?

If the outbreak lasts one or two years, it may produce an enduring “hole in the age structure.” “It’s difficult to define what the effect could be because you don’t know how this epidemic will evolve,” said Jose Miguel Guzman, a former demographer at the United Nations who’s now with the consulting firm ICF International. He noted that there are 10 to 11 million births in Latin America per year, which means the

population would drop by that number if, theoretically, all births were postponed for a year. “This is not a high percentage,” he told me. “Take into account that the population for Latin America is about 634-635 million.” But such a decline could cause the total population in the region, where birth rates have been falling for decades, to grow more slowly or contract sooner than expected. The key variable to watch is how long the Zika outbreak persists. Populations have a way of boomeranging back when temporarily depressed by a war, epidemic, economic disaster, or some other shock to the system, Guzman said. If the outbreak lasts one or two years, it may produce an enduring “hole in the age structure.” But couples in Latin America, who typically have two children, would likely aim for the same family size they’d anticipated before the health crisis, June 2016 — Population Connection 11


Left: A pediatric nurse speaks to new parents about infant care at a hospital in Central Plateau, Haiti. © C. HannaTruscott/Midwives for Haiti, Courtesy of Photoshare. Opposite: A maternity ward in Georgetown, Guyana. © Barry Reinhart/WONDOOR Global Health Program, Courtesy of Photoshare

perhaps compensating for lost time by speeding up their timeline for having kids. A 28-year-old woman who was hoping to have her first child at 30 and her second at 34 might, say, give birth at 32 and 34 instead.

the possibility to have more kids.” That drop in the birth rate might not be canceled out by a subsequent rise, leading to a substantially smaller generation than otherwise would have emerged.

“One year in a school you would have much less kids … but then in two years, they would have double [the number] of kids,” Guzman hypothesized. The socioeconomic repercussions would probably be minimal: Smaller grades for a couple years could mean fewer students per classroom and thus, potentially, better education for those students, but these dynamics wouldn’t have a major impact on educational systems and the labor market.

Such a shift in the age structure could present problems in Latin America, where the informal economy is massive and people tend to not save much money for the future. As a result, the elderly often depend more on material support from their kids and grandkids than on inadequate pension and socialsecurity systems. Countries in the region, Guzman explained, appear to be growing old before they grow rich—a challenge that could be exacerbated by a prolonged struggle to contain the Zika outbreak.

If the Zika epidemic lasts five years or more, however, the calculus could change. In that (very hypothetical) scenario, a significant portion of the women who postponed getting pregnant during the health crisis will be over the age of 35, when pregnancies carry a higher risk, and some of these women “will not have

Some public health experts have questioned the wisdom of the recent government recommendations to avoid getting pregnant, and the advisories have proven politically explosive in largely Catholic countries with some of the strictest abortion laws in the world. (How do you tell Salvadoran women

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to not give birth for the sake of public health, while continuing to criminalize abortion under all circumstances?) But officials appear to be grasping for solutions. Zika is slippery. There’s no vaccine or treatment for the mosquitoborne virus, which is suspected of causing a surge in Brazil of babies born with microcephaly, or an abnormally small head and brain damage. The precise link between the virus and birth disorders remains far from clear. Eighty percent of Zika patients don’t show symptoms. Combatting the virus involves pretty mundane and marginally effective things like spraying pesticides, covering your skin, using mosquito repellent, and dumping standing water where mosquitos can breed (and not-so-mundane things, such as genetically modifying mosquitos to kill off other mosquitos). Guzman, for his part, isn’t so sure that the Zika virus, and the dire government warnings about it, will radically reduce birth rates. In Latin America, he noted, most births are unplanned. A 2014 study


by the Guttmacher Institute found that 56 percent of pregnancies in Latin America and the Caribbean are unintended—a rate that is declining, but still the highest of any region in the world. For that reason, it’s not enough for governments to simply encourage women to put off pregnancy, as if fertility were solely discretionary: “Those women, those couples, have to have the possibility to do so. And for that they need ... quick and good access to high-quality contraceptives and modern methods. And this is something that’s still missing in Latin America.”

www.popconnect.org

Access is particularly difficult for the poorest segments of the population, and especially low-income, adolescent women, in a region with the greatest economic inequality on the planet. That inequality manifests itself in many ways, among them limited opportunities for the poor to receive good education, including sex education, which Church officials sometimes restrict or distort as well. (Still, in Latin America, 67 percent of women of reproductive age who are married or in a union are using some modern method of contraception; in the developing world as a whole, the figure is 56 percent.) High rates of rape in the

region also contribute to the prevalence of unplanned pregnancies. Guzman pointed out that other mosquito-borne diseases like malaria disproportionately affect the poor. “If we think that in the poorest group of the population, the incidence of the Zika virus will be higher, and also the possibility for those women to really not become pregnant is lower, that is the worst combination—the combination of inequality, [lack of ] access to family planning, and also the characteristic of the virus that will be affecting more people who are poor,” he said. “Dealing, in a condition of poverty, with kids [with microcephaly] June 2016 — Population Connection 13


that are not able to be active or to be productive—that will really have an impact in terms of the capacity of families to transform their lives and leave the cycle of poverty.” So far, Guzman hasn’t seen Latin American governments make a serious commitment to widening access to family planning resources as part of their emergency Zika response. Calls to defer pregnancy are reductive unless they’re accompanied by an emphasis on women’s rights and needs, he argued. Without that emphasis, they’re also unlikely to be widely heeded.

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Opposite, top: In Central Plateau, Haiti, a nurse specializing in neonatal care attends to a newborn while its mother is in post-op recovery. © C. Hanna-Truscott/Midwives for Haiti, Courtesy of Photoshare Opposite, bottom: In Central Plateau, Haiti, a father holds his newborn child as his wife, a mother of five, recovers from a deep coma induced by postpartum eclamptic seizures. © C. Hanna-Truscott/ Midwives for Haiti, Courtesy of Photoshare Right: An educator in Quetzaltenango, Guatemala conducts an activity with adolescents to explain about female and male reproductive systems. © Haydee Lemus/PASMO PSI Guatemala, Courtesy of Photoshare Below: In Santo Tomás Milpas Altas, Guatemala, WINGS Family Planning Educator Evelyn registers women to receive the long-term contraceptive methods of their choice. © Anna Zatonow/WINGS Guatemala, Courtesy of Photoshare

www.popconnect.org

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In Latin America, an exception to falling birth rates draws new scrutiny

A mother sleeps next to her newborn baby in Georgetown, Guyana. © Barry Reinhart/ WONDOOR Global Health Program, Courtesy of Photoshare


Dramatic progress has masked the fact that poor communities are lagging far behind wealthier ones in controlling family size—perpetuating inequality. By Whitney Eulich, Correspondent, and Catherine Osborn, Contributor Originally published by The Christian Science Monitor

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In Brazil, one of the most dramatic examples, mothers now have 1.7 children on average.

L

she totes her 3-month-old son around a buzzing children’s party. For Stuart, who is in her late 30s, completing her education and advancing her career were priorities.

“I saw the effect it had on [my mother and grandmother’s] lives,” she says, as

Across Latin America, the stereotype of the large, young family is being challenged as fertility rates plummet. Girls’

ike most of her peers, Renata Stuart has—and wants—only one child. That’s a big change from previous generations: Ms. Stuart grew up in Rio de Janeiro with three siblings, while her mother had 10.

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access to education has improved, greater numbers of women have entered the workforce and gained more control over their finances, and family planning methods have expanded in recent decades. In Brazil, one of the most dramatic examples, mothers now have 1.7 children on average—from 6.3 children


Opposite: Simeus holds the youngest of his four daughters in Central Plateau, Haiti. © C. Hanna-Truscott/Midwives for Haiti, Courtesy of Photoshare. This page: Mama Juana Perugachi, a midwife working at Jambi Huasi, a primary health clinic in Otavalo, Ecuador, focuses on integrating western medicine and traditional Andean practices. © Kimberly Salazar, Courtesy of Photoshare

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This page: Community health workers conduct home visits to deliver health education, vaccines, and checkups to children under five in rural Léogâne Commune, Haiti. © Lauren Zalla, Courtesy of Photoshare. Opposite (top and bottom): Women in Central Plateau, Haiti wait for skilled prenatal, postpartum, and gynecological care given by a graduate of Midwives for Haiti. © C. Hanna-Truscott/Midwives for Haiti, Courtesy of Photoshare

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in 1960. That’s lower than the U.S. birth rate, and signals a shrinking population. The trend is generally viewed as a good thing—evidence of a wealthier and healthier society, where parents aren’t operating under the assumption that a child may die from malnutrition or disease. It reflects a higher number of girls staying in school and then working. And it signals changed attitudes toward women’s central roles. But falling national fertility rates may mask a nagging problem across the region: inequality. While Stuart and her peers are choosing the number of children they would like to have, women in rural areas or in poorer urban enclaves are often having more children than they express wanting, outpacing national and regional averages. The rich-poor divide has been overlooked, in part, due to the positive national declines that led to the withdrawal of or decreases in funding for maternal health efforts, experts say. But from southern Mexico to Brazil, and El Salvador to Panama, awareness of the dichotomy is growing, and prompting efforts to get more nuanced assessments of what’s really happening in order to ease poverty and inequality. “What really surprised me … in this region is that there were still some communities that had the same low access to services and quality care as we find in the poorest communities in Africa and Asia,” says Mariam Claeson, director of maternal and newborn health for The Bill and Melinda Gates Foundation and who works on the Mesoamerican Health Initiative, a public-private partnership that targets the poorest 20 percent of populations in Central America and southern Mexico to provide increased access to maternal health services and education. “We have been a little too comfortable with our average indicators for maternal and www.popconnect.org

June 2016 — Population Connection 21


newborn health,” adds Emma Margarita Iriarte, who manages the Inter-American Development Bank’s (IADB) contributions to the same project. So far, the Mesoamerican health program has seen some positive results in short order, suggesting that awareness has been crucial. In an 18-month time frame, for example, almost all of Nicaragua’s poorest health clinics were able to offer modern family planning methods, a 30 percent rise. Panama also boosted availability of supplies to nearly 100 percent of its poorest community clinics, up from 10 percent. And in El Salvador, almost 80 percent of clinics

22 Population Connection — June 2016

now have working refrigerators—a crucial supply storage tool—up from about 43 percent before the intervention was launched. Guatemala and El Salvador have also seen progress.

‘Unsatisfied Demands’ for Family Planning In Mexico, where women have 2.2 children on average, there’s been nearly a one-third drop in fertility since the 1970s. But the disparity based on income and region is readily evident. Fruit-seller Lara Torres, who grew up with four siblings and whose mother had

seven brothers and sisters, decided early on that she wanted to keep her family small. “I wanted more flexibility to give my kids things my parents couldn’t give me, to move [my family] ahead,” says the Mexico City resident, mentioning the possibility of luxuries like a bilingual education or family vacations. But Ms. Torres says she got pregnant unintentionally when she was 18. She now has four kids, two more than she’d hoped or planned for.


Opposite: A grandfather in Central Plateau, Haiti holds his granddaughter while the baby’s father exchanges smiles with his daughter. © C. Hanna-Truscott/Midwives for Haiti, Courtesy of Photoshare. Below: Midwives in Otavalo, Ecuador learn how to take a pulse during a Midwife Training Program led by Jambi Huasi and GlobeMed at Loyola University Chicago. © Kimberly Salazar, Courtesy of Photoshare

That’s troubling for people like Ms. Iriarte from the IADB. She says even when most women across the region are reporting they want fewer children than past generations, those in the poorest 20

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percent of the population often end up having more than their “ideal” number. Many Latin American countries have national healthcare systems, but most still struggle to deliver widespread, highquality services. Some, like Mexico, Brazil, Nicaragua, and Honduras tie a handful of such services—like giving birth in a hospital or using contraceptives after delivering a child—to conditional cash-transfer welfare programs, which are linked to recipients’ behavior. In some cases, governments have difficulty supplying health clinics in rural areas or informal urban settlements.

A lack of sexual education or qualified health providers is common in the most impoverished communities, experts say. Some countries, like Honduras, require that medical students spend the last year of their education programs working in less desirable posts like rural towns, which can lead to frequent turnover and less experienced service providers. Getting kids to stay in school is also important, but rural schools in particular may not teach past the fifth grade. In Brazil, the most recent government data shows that women with four or fewer years of study have on average one more child than they want.

June 2016 — Population Connection 23


In Panama, about 68 percent of the overall population uses some form of contraception, while that figure is just 9 percent in typically poor indigenous communities. “That’s a [nearly] 60 percent gap in the same country. In a country that’s one of the richest in the region, that has resources,” says Iriarte. In Chiapas, one of the poorest states in Mexico and home to one of the country’s largest indigenous populations, midwife Cristina Alonso Lord points to discrimination and a lack of cultural understanding. She says many rural, indigenous communities are misinformed about what contraception methods are available to them and how they might affect their bodies. Myths, like the idea that taking birth control will increase a woman’s sexual appetite, are also deterrents in these typically conservative communities. “There isn’t great communication between doctors and patients in Mexico,” says Ms. Alonso Lord, who practiced in the state before opening a practice in Mexico City two years ago. “But it’s even worse when it comes to indigenous populations.” She cites examples like hospitals that won’t let a mother leave after giving birth without a method of contraception, yet don’t give the mother a chance to really ask questions. “What is needed is … for mothers to be able to make decisions based on their vision for their own lives instead of being told by a doctor what they are required to do,” she says. Still, progress has come quickly in some areas that have gotten more targeted help. “There are unsatisfied demands for family planning,” says Esteban Caballero, the Latin America regional director for the United Nations Population Fund. “It creates a situation where child rearing and education, and the possibility of helping children to take advantage of certain opportunities, becomes more difficult and challenging. “The consequences of not having [the tools] to decide family size reach into the future,” says Mr. Caballero. “The poor are more likely to stay poor.”

24 Population Connection — June 2016

A family planning user and a health promoter discuss contraceptive methods in El Quiché, Guatemala. © Haydee Lemus/PASMO PSI Guatemala, Courtesy of Photoshare


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Washington View

Everything Old Is New Again By Stacie Murphy

A

s Washington readies for the coming election season, President Obama’s last budget battle begins, the Supreme Court considers birth control coverage, and a House panel “investigates” Planned Parenthood. If it feels like we’ve been here before, well…

President Obama Releases Final Budget Outline

In early February, President Obama unveiled the final budget proposal of his presidency. On international family planning, this budget calls for $620 million—a $12.5 million increase over the current level—enacted via an omnibus spending bill passed in December 2015. It also proposes increasing United Nations Population Fund (UNFPA) funding to $35 million—undoing a $2.5 million cut included in that December bill. On the domestic side, the budget calls for funding Title X at $300 million, a slight increase from the current $286.5 million. While this is unquestionably a positive step, Title X, like international family planning, is still woefully underfunded and unable to meet the current—and growing—demand for care among lowincome populations across the United States. The president also proposed an additional $4 million in funding for the 26 Population Connection — June 2016

Teen Pregnancy Prevention Initiative (TPPI), bringing the total funding for that program to $105 million. TPPI helps support effective, responsible sex education efforts across the country. A similar program, the Personal Responsibility Education Program (PREP), earned an extension—at $75 million annually—for five more years, to 2023. Finally, the budget calls for the elimination of funding for discredited abstinence-only programs. Though it has been customary since the 1970s for the chairs of the Senate and House Budget Committees—currently Sen. Michael Enzi (R-WY) and Rep. Tom Price (R-GA)—to invite the White House Budget Director to testify about the budget proposal, this year proved to be exceptional. In a polarizing move, the two released a joint statement cancelling the hearings and disinviting the Office of Management and Budget Director from testifying. From this and other indicators, it looks like the 2017 budget fight will be as bruising as ever.

Groundhog Day at the Supreme Court

On March 23rd, the shorthanded Supreme Court heard oral arguments on a case dealing with the right of employers

to refuse to include birth control in their employees’ health plans. But wait, wasn’t there already a case about this a couple of years ago? And wasn’t there some sort of accommodation made for those employers? Yes, and yes. But here we are again, regardless. The justices considered the case of Zubik v. Burwell, in which the plaintiffs challenged the Obama Administration’s birth control accommodation for religious non-profits. That accommodation, you may remember, which the Obama Administration put in place after the notorious Hobby Lobby decision, allowed any employer who objected to covering birth control to opt out by filing a two-page form notifying the government of its objection. Once notified, the government would work with the insurance company to reach out to affected employees and make sure they were covered independently of their workplace plans. In its majority opinion in the Hobby Lobby case, the court offered exactly this mechanism as an example of an acceptable compromise. One would generally assume that such an endorsement would mean the compromise was unquestionably constitutional. Apparently not in this instance. The Zubik plaintiffs argue that filing the form makes them “complicit” in their employees’ use of birth control, because


the form “triggers” their ability to receive coverage. It is, therefore, a substantial burden on their religious freedom.

We expect a decision by the end of June. Or not. The likelihood of a tie vote is quite real.

After oral arguments in which several justices seemed all too ready to agree with the plaintiffs, the court took the highly unusual step of issuing an order requiring additional briefs from all parties. These briefs were to outline possible mechanisms for ensuring birth control coverage without burdening religious practice.

House Panel “Investigates” Planned Parenthood

The plaintiffs offered the entirely unworkable suggestion of a separate birth control-only insurance plan, and suggested that any required action on their part that ended with employees having birth control access was unacceptable. The administration, quite rightly in our view, argued that the plaintiffs’ suggestions were not feasible. They pressed for the court to uphold the current structure, pointing out that unless the court issues an unequivocal decision, anyone who was not a party to the current case would be free to argue that any new accommodation is also an unacceptable burden on their religious practice, and the cascade of lawsuits challenging ever-more-circuitous accommodations will never end.

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In April, the “Select Investigative Panel on Infant Lives” held what became the fifth hearing to discuss allegations of illegal conduct by Planned Parenthood. House leadership formed the not-atall-hysterically-named panel after the now-discredited Planned Parenthood “sting” videos surfaced last summer. The heavily edited videos purported to show Planned Parenthood employees violating federal law by profiting from sales of fetal tissue. The creator of those videos, David Daleiden, is currently the subject of a criminal investigation in California and was indicted by a Texas Grand Jury that was convened by an anti-abortion District Attorney to investigate his allegations against Planned Parenthood. Planned Parenthood was cleared of any wrongdoing. But that verdict, four other House hearings, and 12 separate state investigations of Planned Parenthood (none of which have found any evidence of criminal activity) are apparently not enough for House Republicans. Republican panel members spent their time insisting that

they had uncovered evidence of crimes, while Democratic members pointed out that this “evidence” was unsourced and unverified. Rep. Diana DeGette (D-CO) repeatedly asked panel chair Rep. Marsha Blackburn (R-TN) to either provide explicit sources for her claims or withdraw them. Blackburn refused to do either. The evasions eventually led a furious Rep. Jackie Speier (D-CA) to declare that “[t]his socalled committee is the very definition of a kangaroo court … that disregards the rules of law and justice to validate a predetermined conclusion.” At the end of the hearing, DeGette reiterated her criticism of the panel’s process, saying that “if people are selling fetal tissue in violation of the law, then we need to have an investigation. But we can’t have some witch hunt based off some things that were taken off of screenshots and charts created by [House] staff … if you want to send it to the Department of Justice for investigation, I’ll guarantee you, they won’t make up little charts with their staffs. They will get to the bottom of it with original documents, and I suggest that’s what you should do if you think there is a criminal violation.” As of our deadline, House Republicans have not announced any plans to do so. June 2016 — Population Connection 27


Field & Outreach

Photos by Bill Petros Captions by Alexandra Behette, Senior Field Assistant

Capitol Hill Days 2016

Capitol Hill Days 2016 was an incredible success thanks to all of the inspiring activists who used their voices to empower women everywhere. Above: Vee Mkandawire and Mellina Chinkhondo

Population Connection Action Fund presented its second annual Empower Her, Empower Humanity Award to Sen. Harry Reid for his unwavering dedication to women’s rights and access to comprehensive reproductive healthcare. The award was introduced by Brian Dixon, SVP of Media and Government Relations, and Jean Perry-Jones, longtime CHD participant and Nevada resident. It was accepted on Sen. Reid’s behalf by two of his staff, McKenzie Bennett and Kimberly Miller-Tolbert.

Karen Hampanda and Ana Gutierrez join National Field Director Rebecca Harrington on stage for a mock constituent meeting, giving participants an idea of what to expect in their Monday meetings

Lauren Reiche and Sydney Rasch, law students at the William H. Bowen School of Law–University of Arkansas at Little Rock, meet with Sen. John Boozman

Jasmine Jackson, Rickey Leachman, and Selyna Villareal meet with Sen. Patty Murray’s staff

28 Population Connection — June 2016


Capitol Hill Days 2016 drew 173 advocates from 27 states and 75 congressional districts who visited 153 offices in one day on Capitol Hill!

There were so many Arizona State University students visiting Rep. Kyrsten Sinema’s staff that they had to hold their meeting in the hallway of the Longworth House Office Building! Pete Galvan, speaking in the photo above, says that he “would highly recommend participating to any student interested in human rights, reproductive health, or getting involved in advocacy.”

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Participants from Colorado meeting with Rep. Diana DeGette’s staff. Constituent lobbying offers the chance for activists to advocate for the millions of women affected by U.S. foreign policy who depend on international family planning aid. In-person meetings demonstrate a level of commitment to the issue that makes members of Congress take notice!

June 2016 — Population Connection 29


Over 3,800 Students Take on PopEd’s Video Challenge PopEd

By Pamela Wasserman

W

hat started as a way to commemorate the “7 billion” milestone in 2011 has turned into an annual, international event, engaging students and teachers worldwide to “make the population connection” through moving messages. This year’s contest saw a sharp rise in entries—1,983 (more than double last year’s contest), with over 3,800 students participating. Part of this increase can be attributed to opening the contest up to middle school students this year. But even among high school students, we received 64 percent more entries than last year, with many more teachers using it as a class assignment to engage their students on critical global issues central to both environmental science and social studies curricula. Videos were submitted from schools in 28 countries and 42 states plus Puerto Rico and American Samoa. For the 2015-16 contest we focused on three global challenges: deforestation, public health, and water scarcity. Students were challenged to create a short video (up to 60 seconds) about human population growth that highlights one of these challenges. To be viable contenders, videos had to include connections to population growth and at least one idea for a sustainable 30 Population Connection — June 2016

solution. Because the challenges were broad, we also offered some subthemes to help students narrow their focus, and suggested resources and background readings to start their research.

High School—2nd Place

Earlier this spring, we sent surveys to all of the students who submitted videos to get their valuable feedback on their participation and to help us craft future contests. One survey question asked them about their choice of topics. Many mentioned first-hand experiences with their film subject:

Sophia Wu

“We are experiencing the Southern California drought so we thought that it would be a great idea to spread awareness about the problem.” “Deforestation is a really huge issue everywhere, including the country we live in (Nicaragua). We wanted to express ourselves and our concern in every way possible, and we thought this would help. Even the smallest candle can bring light to a dark room.” A panel of 45 judges, including college and high school educators, filmmakers, and professionals working in the topic fields, selected the winners. Winners received certificates and cash prizes.

Victor Elgersma Brussels, Belgium

Mia Freund New York, NY

San Francisco, CA

Middle School—2nd Place William Griffith South Orange, NJ

Samantha Guerrier Virginia Beach, VA

Leilani Hyatt

Virginia Beach, VA

High School Honorable Mentions Bryan Sturm Ventura, CA

Josh Joireman Pullman, WA

Joe Morris Montesano Denville, NJ

Victor Elgersman Brussels, Belgium

Christelle Chavannes Chicago, IL

Philip Jones Snellville, GA


Joanna Gerr : Deforestation

Joanna, a senior at Thomas Jefferson High School for Science and Technology in Alexandria, Virginia, has been animating films since middle school. Her skill and thoughtfulness show in “One Stump at a Time,” our winning video on deforestation. “I had the thought that if Mother Nature were a real entity, she’d be mighty disappointed with us for eating away at her trees like a bunch of termites,” she writes. Joanna will be heading off to MIT this fall to pursue her interests in media arts and sciences.

You can view this year’s winning entries, along with the students’ photos and bios on our contest website, www.WorldOf7Billion.org.

High School 1st Place Laura Paglicawan: Public Health Laura’s video, “Loving Her,” won the judges over with its sensitive treatment of maternal health, using a personal journal to show the preventable diseases that affect women worldwide. “Everyone should have a healthy life with opportunities,” writes Laura. A senior at Stephen J. Austin High School in Sugar Land, Texas, Laura will be heading off to the University of Houston this fall.

Leo Bopp and Jacob Furniss-Yesk: Water Scarcity

Jake and Leo, sophomores at Lycée Français de Chicago, created “Reduce, Reuse, Recycle Water” to take our top prize in the water scarcity category. They decided to focus their video animation on using grey water as a means to conserve water resources. One of our judges, a leading expert on freshwater, lauded the piece for showing the “best solutions offered of all videos—they hit on the things that will matter most in reducing water scarcity both here in the U.S. and globally.”

Holly Golightly: Deforestation

A 7th grader at Noblesville West Middle School in Indiana, Holly enjoys drawing, which she used to great effect in “Why Take it All Away?” An environmental writer judging the contest described the video as a “clear explanation of why deforestation contributes to climate change in just one minute—very impressive!”

Middle School 1st Place Henry Castillo: Water Scarcity

“What Would We Do Without Water?” is the winning entry from Henry Castillo, a 7th grader at Harmony Science Academy in Carrollton, Texas. He sees water scarcity as one of the biggest global challenges that also hits home—in recent years Texas has been struck by destructive droughts. Judges described Henry’s video as “exceptional and moving” and “very compelling.”

Dahna Yoon: Public Health With aspirations of becoming a doctor someday, it’s no surprise that Dahna Yoon chose to focus her video on public health. An 8th grader at Harrisburg Academy in Wormsleysburg, Pennsylvania, Dahna created “Spread of Communicable Disease” as an assignment in her Global Issues class.


The Good Crisis How Population Stabilization Can Foster a Healthy U.S. Economy Featuring Authors: David Bloom, John Seager, and Hal Marcovitz The Good Crisis proposes that progressive social and workplace changes can promote economic prospertity—without increasing birth rates. The expert authors demonstrate 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, while protecting our natural resources from unsustainable population growth.

The Good Crisis is Available Now! To download a free PDF or purchase a hard copy, please visit www.thegoodcrisis.org.

32 Population Connection — June 2016


Editorial Excerpts

The question in the Zubik case is a simple one: Do religious objectors get to disobey the laws they dislike, even when that places burdens on others? The case arose out of a dispute over the Affordable Care Act’s requirement that employers’ health plans provide free contraceptive coverage to their employees. The Obama Administration exempted churches, mosques, synagogues, and other houses of worship from the requirement. When nonprofit organizations with religious affiliations, like universities, hospitals, and socialservice groups, argued that they, too, should be exempt, the administration offered them an easy way to opt out: notify their insurer or the government, in writing, of their refusal to provide coverage. At that point, those organizations have no further role in the process; the government takes over and ensures that employees are given free access to contraceptives. This accommodation struck a reasonable balance between the government’s respect for religious freedom and its strong interest in carrying out the law’s mandate. But it was still not enough for many religious-affiliated employers, who said that the very act of notification makes them complicit in the provision of contraceptives and violates their religious freedom.

Now that researchers have identified a tangible link between the Zika virus and fetal brain deformation, pregnant women and those of childbearing age in the Latin American countries hardest hit by the mosquito-borne virus will have to make tough decisions about their reproductive future. Use birth control? Abstain? Abort if there’s evidence of potentially lethal birth defects? Or at least that’s how it ought to go. In reality, women in many Latin American countries have almost as little control over their bodies as they do the weather. They are subject to rampant sexual violence, have received little or no sex education, and may have limited access to birth control. When they do get pregnant, abortion is illegal in most countries, though some have exceptions in cases of rape, fetal impairment, or danger to the life of the mother. In El Salvador the strictures are particularly harsh. There are no legal abortions, and women may go to jail for the “crime” of suffering miscarriage.

Notifying the government of a refusal to provide birth control coverage is not a substantial burden on religion, nor does that notification “trigger” the coverage, which is already guaranteed under the law.

These realities make the paltry governmental response in El Salvador and like-minded countries—warning women not to get pregnant until the Zika crisis is over—all the more ludicrous. Just how does it help to scare women while offering no tools or information? It’s unrealistic, and even irresponsible, to expect women to somehow stave off pregnancy when birth control isn’t an option and rape is widespread.

Such reasoning has no logical endpoint. The Zubik case is not about questioning anyone’s religious beliefs; it is about how those beliefs must coexist within a large and religiously diverse nation.

Left unsaid is that the inability of women to control their bodies in a most basic way has a direct impact on their economic situation—and that the Zika epidemic could make things even worse for them and their families.

—March 21, 2016

—February 17, 2016

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June 2016 — Population Connection 33


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