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Volume 51, Issue 3 September 2019

A Better Guatemala:

Indigenous Women Break the Cycle of Isolation, Oppression, and Abuse

President’s Note


rapid population growth trigger a total collapse?

It already has. Just ask the 9 million residents in and around Chennai, India, where the wells have run dry. Another 20 Indian cities face the same fate within 18 months. More than half that nation is already dealing with high-to-extreme water stress, which results in the deaths of 200,000 people each year. Ask the citizens of Kiribati, Tuvalu, and the Maldives—Pacific island nations threatened by oceanic inundation due to climate change. Ask the 15,364 scientists who’ve warned that “we have unleashed a mass extinction event, the sixth in roughly 540 million years, wherein many current life forms could be annihilated or at least committed to extinction by the end of this century.” Collapses generally don’t follow the plot line of those Hollywood movies where everything, everywhere goes to hell all at once. In the real world, one catastrophe often triggers the next. Just consider the

fate—and the impact—of the 70 million people now displaced from their homes, nearly double the number just a decade ago. We regularly hear from the demographic equivalent of the Flat Earth Society who argue that none of this is due to population growth. Tell that to Indian women standing for hours in long lines under the scorching sun to fill water jugs. Tell that to villagers fleeing famine, drought, or civil chaos in Africa, Asia, and Central America. Some people seem strangely comforted that world population might possibly stop growing by 2100 or thereabouts. The most recent UN medium projection indicates we’ll add another 3.2 billion people by the end of the century. Who in their right mind thinks the earth would be improved by population growth equal to all current inhabitants of the Western Hemisphere plus Africa? One of our members asked me recently if I thought population growth was the world’s biggest challenge. I replied that it certainly qualifies, and that virtually

every other global challenge is exacerbated by population growth. It stands out because we absolutely know how to achieve zero population growth: by smashing all barriers to reproductive health services. Hania Zlotnik, a distinguished former board member of Population Connection and the first woman to serve as Director of the UN Population Division, says that if we want a different future, we must “change the now.” Step One involves doing everything possible to ensure that every pregnancy—and at the very least, every birth—everywhere is intended. Yet we’re moving in the opposite direction. Trump’s odious Global Gag Rule has dramatically increased unintended pregnancies in some of the poorest places on earth. Here at home, Trump has imposed a  Domestic Gag Rule, which will devastate family planning programs across our nation. Every day brings news of another catastrophe. We must counter fanaticism with facts and enlist a rising generation. Time is short. John Seager john@popconnect.org


Population Connection — September 2019

Volume 51, Issue 3 September 2019

Board Chair Estelle Raboni, MPH, MCHES Board of Directors Aaron S. Allen, PhD Andreea Creanga, MD, PhD Amy Dickson Katie Ferman Bryce Hach, MS (Secretary) Mark Hathaway, MD, MPH Padgett Kelly, PhD Nejla Liias, MPP Sacheen Nathan, MD, MPH Bob Pettapiece, EdD Dara Purvis, JD (Vice Chair) The Hon. Tom Sawyer (Treasurer) Kevin Whaley, PhD

Feature 10

Good Women: Guatemalan Survivors of GenderBased Violence Transform Their Pain to Purpose By Lisa J. Shannon


President and CEO John Seager john@popconnect.org Editor Marian Starkey, MSc marian@popconnect.org 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 populationconnection.org populationeducation.org popconnect.org/magazine-archives



Editor’s Note


Letters to the Editor


Pop Facts


In the News


Earth Day 2019


Washington View


Field & Outreach






Editorial Excerpts

Cover Image: Women’s Justice Initiative Director of Programs Elvia Raquec outside a domestic violence training workshop in rural Guatemala | Lisa J. Shannon

September 2019 — Population Connection


Editor’s Note


’m going to open my column by quoting someone who’s probably best known for suggestively licking a sledgehammer and flying through the air on a wrecking ball wearing nothing but burgundy combat boots. Miley Cyrus started her career as a young teen on Disney Channel’s “Hannah Montana.” She went on to become an award-winning, chart-topping pop star whose sexuality was on full display (see above). She became the founder of an organization (Happy Hippie Foundation) that helps LGBTQ youth and homeless youth in Los Angeles, in 2014. Around the same time, she became a super advocate for vegan food and fashion (she and her husband, Liam Hemsworth, had a vegan wedding in 2018, and they both shun leather and fur in favor of vegan alternatives). Now, she’s an unlikely (and probably inadvertent) advocate for population stabilization. When interviewed for ELLE in July, and asked about the Woolsey wildfire that claimed her Malibu home last year, Cyrus responded: With natural disasters, you don’t get a choice. You surrender. … The earth is angry. … We’ve been doing the same thing to the earth that we do to women. We just take and take and expect it to keep producing. And it’s exhausted. It can’t produce. Then her thoughts turned to her own reproduction: Until I feel like my kid would live on an earth with fish in the water, I’m not bringing in another person to deal with


Population Connection — September 2019

that. … [Millennials] don’t want to reproduce because we know that the earth can’t handle it. [Women are] expected to keep the planet populated. And when that isn’t a part of our plan or our purpose, there is so much judgment and anger that they try to make and change laws to force it upon you—even if you become pregnant in a violent situation. If you don’t want children, people feel sorry for you, like you’re a cold, heartless bitch who’s not capable of love. Her take might be harsh, but it’s hard to argue against. I’d bet that all of us without children have had to bear the disdain of people who thought we were demented for not wanting to become parents. What’s truly demented, though, is forcing people to bear children they don’t want or can’t properly parent. That’s what the current U.S. presidential administration is trying to do with its family planning funding cuts and abortion restrictions. And it’s what this issue’s featured author identifies as a major factor keeping women from achieving their full potential in rural Guatemala. Lisa Shannon relays stories of indigenous Mayan women who beat the odds, becoming community health workers after surviving abuse at the hands of men and of the state. These Guatemalan women bring credibility and relatability to their outreach, and through their efforts and their examples, they’re changing the lives of their patients and community members, one household at a time. Marian Starkey marian@popconnect.org

Letters to the Editor

The message of Volume 51, Issue 2, is as loud and clear as I have ever read, seen, or heard: Educate and empower women worldwide. In the 1950s, I understood that overpopulation would be the cause of untold suffering and death in every habitat and biosphere. I weep for the lost life and systematic extinction of plants and animals that is happening due to the activities of humans hell-bent on making a profit at the expense of all in their path. Maybe the reality of overpopulation will sink in for enough folks that earth will not end up trashed and polluted for our children’s children. Thank you, Population Connection. Your dedication to empowering women may be the saving grace. Norman Bean Thank you so much for your work. For 50 years I have been shouting the obvious basic environmental and economic scourge behind all human interactions: For a long time, there have been too many of us on earth, and our numbers still expand. The only thing that has prevented endless worldwide devastating famine and economic destruction is the advancing, but inconsistent, technological rescues. Those allowed our evergreater access to resources at the cost of habitat depletion for most other species. George W. Stiffener I just wanted to send a note to tell you how much I enjoyed your focus on E.O. Wilson—especially your interview of him. Bringing his insights to the Population Connection audience is a real service. 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 2120 L St NW,


Suite 500 Washington, DC 20037

I had the pleasure of meeting him some years ago at a function of my organization, and he is indeed a wonderful, down-toearth person, despite being a world-class scientist and masterful communicator on topics of enduring importance. And none is more important than overpopulation/overconsumption. David Harmon It was brilliant to do a cover story on E.O. Wilson. Several years ago, I read his book The Social Conquest of Earth, which includes insights that could, if shared by every person on the planet, change our view of life on earth and of humans’ role in it. Most people just do not understand evolution or population dynamics at a deep level. Jane Roberts The E.O. Wilson issue of Population Connection is fabulous! Dr. Wilson is a world treasure, and your writing in “An Afternoon With an Ant Man” is absolutely wonderful. I smiled and pictured the whole scene as I read, though I was sobered by the message. We receive a hard copy of the magazine in the mail. Is it possible to have a link to an electronic version so I may share your article with biologist colleagues overseas? Thank you for your great writing and for considering a possible electronic version. Andrea Tuttle, PhD Thanks, Dr. Tuttle! All issues of Population Connection are online at popconnect.org/magazine-archives! –Marian

September 2019 — Population Connection


2019 World Population Prospects: The world’s population is projected to grow:


2019 7.7 billion people

8.5 billion people

The population of sub-Saharan Africa is projected to double by 2050.


Other regions will see varying rates of increase between 2019 and 2050:

Oceania Excluding Australia & New Zealand


Northern Africa & Western Asia


New Zealand & Australia


South-Eastern & Eastern Asia


km km

Latin America & the Caribbean


Source: United Nations, Department of Economic and Social Aairs, Population Division (2019). World Population Prospects 2019: Ten Key Findings. Design: Mali Welch

New Data from the UN Population Division 2100

2050 9.7 billion people

10.9 billion people

Rapid population growth presents challenges for sustainable development. Many of the fastest growing populations are in the poorest countries, where population growth brings additional challenges in the eort to eradicate poverty, achieve greater equality, combat hunger and malnutrition, and strengthen the coverage and quality of health and education systems. Today, close to half of all people globally live in a country or area where fertility is below 2.1 births per woman over a lifetime. In 2019, fertility remains above this level, on average, in sub-Saharan Africa (4.6), Oceania excluding Australia/New Zealand (3.4), Northern Africa and Western Asia (2.9), and Central and Southern Asia (2.4).

Southern & Central Asia


Since 2010, 27 countries or areas have experienced a reduction in the size of their populations of one percent or more. This is caused by low levels of fertility and, in some places, high rates of emigration. In 2019, life expectancy at birth in the least developed countries lags 7.4 years behind the global average (72.6), due largely to persistently high child and maternal mortality, as well as violence, conict, and the continuing impact of the HIV epidemic.

Europe & Northern America



* The UN grouped these two regions together in its report, but doing so obscures their very different growth trajectories. Northern America is projected to grow by 15%, while Europe is projected to shrink by 5%.

September 2019 — Population Connection





Birth Control Benefit Protected by Appeals Court The U.S. Justice Department failed to convince the courts that employers should be permitted to withhold birth control coverage in employee insurance plans on religious or moral grounds. A federal judge already ruled against the Trump administration on its religious exemption in January, issuing a temporary injunction and preventing the exemption from going into effect until a hearing with a full court of appeals could occur. The 3rd U.S. Circuit Court of Appeals in Philadelphia upheld that injunction in July, citing the lack of a public comment period, which is standard for executive level rule changes.

Tanzanian President Urges Women to Have More Babies for the Economy President John Magufuli, in office since 2015, urged Tanzanian women to have more children in order to raise the population growth rate. Speaking to a crowd in his home town of Chato, Magufuli said, “I know that those who like to block ovaries will complain about my remarks. Set your ovaries free, let them block theirs. … When you have a big population you build the economy. That’s why China’s economy is so huge.” According to the latest UN estimates, Tanzania’s total fertility rate is 4.9 births per woman, and the population is growing by 3 percent a year—at that rate, the population would double in 23 years. 6

Population Connection — September 2019

Global Gag Rule Leads to Higher Abortion Rates In 2011, researchers at Stanford University published a study that explored abortion data in the subSaharan African countries at highest risk of losing U.S. family planning aid due to the Global Gag Rule. They compared data for 20 African countries during the Clinton and Bush administrations (1994–2008), and found that when the Gag Rule was in effect under George W. Bush, abortion rates more than doubled in the countries most affected by the funding cuts. In June, the Stanford researchers published an update to their original research. This time, they looked at 26 African countries, and they expanded their period of study to 1995–2014 to include part of the Obama administration, during which the Gag Rule was not in effect. They found that in the countries most affected by the Gag Rule during the Bush administration, abortion rates were 40 percent higher than they were during the Clinton and Obama administrations, when the policy was not in effect. “Our research suggests that a policy that is supported by taxpayers ostensibly wishing to drive down abortion rates worldwide does the opposite,” says Eran Bendavid, one of the study’s authors. The elevated abortion rates are likely due to diminished contraceptive access when the Global Gag Rule is in effect: Organizations that cannot agree to the conditions of the Gag Rule lose their

U.S. family planning funding. This causes supplies to dry up, staff to be laid off, and clinic doors to close. Another of the study’s authors, graduate student Nina Brooks, says, “By undercutting the ability to supply modern contraceptives, the unintended consequence is that abortion rates increase.”

UN Releases New Population Estimates and Projections The United Nations Population Division publishes new population estimates and projections every two years. The 2019 revision of the World Population Prospects estimates the 2015 population (which is used as the base year for population projections) to be 3.2 million people lower than it was estimated to be in the 2017 revision. Compared to the 2017 revision, the 2019 revision projects the 2030 population to be 2.7 million lower; the 2050 population to be 36.8 million lower; and the 2100 population to be 309.5 million lower. Key highlights from the 2019 World Population Prospects are depicted in this issue’s Pop Facts feature, pp 4–5.

CDC Releases Provisional 2018 Births Data The Centers for Disease Control (CDC) released provisional data in May on U.S. births for 2018. The total number of births was 3,788,235—the fewest in 32 years. The total fertility rate declined to 1.73 births per woman. The birth rate for teenagers (15–19) declined 7 percent in

2018 to 17.4 births per 1,000 women. These data are based on 99.73 percent of 2018 births; final results will be published this fall.

New Planned Parenthood President “Removed” In July, Dr. Leana Wen, Planned Parenthood’s President since November 2018, was removed from her position. Dr. Wen said in her statement about stepping down, “I am leaving because the new Board Chairs and I have philosophical differences over the direction and future of Planned Parenthood.” Alexis McGill Johnson, a Planned Parenthood board member (and former chair), has assumed leadership until a replacement is found.

Some States Pass Unconstitutional First Trimester Abortion Bans… Mississippi Gov. Phil Bryant signed a 6-week abortion ban into law in March. It was scheduled to go into effect in July, but was blocked in May by a temporary injunction issued by U.S. District Judge Carlton Reeves. Mississippi only has one remaining abortion provider, in Jackson. Ohio Gov. Mike DeWine signed a 6-week abortion ban into law in April, with only one exception: to save the life of the pregnant person. U.S. District Judge Michael Barrett issued a preliminary injunction against it in July. Louisiana Gov. John Bel Edwards signed a 6-week abortion ban into law in May. Gov. Edwards calls himself a “pro-life www.popconnect.org

Democrat.” The only exceptions to the law are to save a pregnant person’s life or prevent “serious risk” to their health. The law will only go into effect if the Mississippi law is upheld. Georgia Gov. Brian Kemp signed a 6-week abortion ban into law in May. Hollywood actors immediately threatened to cease working in Georgia if the law is allowed to go into effect (the state is a popular filming location). Missouri Gov. Mike Parson signed an 8-week abortion ban into law in May, with an exception for medical emergencies only. The state is also trying to shut down its last abortion clinic, in St. Louis, claiming that the doctors who work there have refused to be interviewed in order to secure a renewal of the clinic’s license. The doctors were told that agreeing to the interviews could open them up to criminal investigation, and are therefore wary of proceeding. In July, Oklahoma County District Judge Cindy Truong upheld a 2015 law banning the safest method for providing second trimester abortions: dilation and evacuation. The law effectively bans abortion at 14 weeks in Oklahoma. The most egregious abortion ban in these past few months occurred in Alabama, which passed a law criminalizing the procedure at any point in pregnancy. Gov. Kay Ivey signed the bill—the strictest in the country—into law in May. The only exceptions to the law are when the life of the pregnant person is at risk

or when the fetus has a fatal anomaly. Doctors who provide abortions outside these exceptions could face up to 99 years in prison.

…While Other States Move to Protect Abortion Access Rhode Island Gov. Gina Raimondo signed a bill in June to codify Roe v. Wade, enshrining abortion rights in the state should Roe be overturned. Maine passed two pieces of legislation that expand abortion rights: one allows advance practice clinicians to provide abortions (in addition to physicians) and another requires MaineCare, the state’s version of Medicaid, and employer-based insurance plans to cover abortion if they also cover maternity care. Opponents of the latter bill are collecting signatures in an effort to place a people’s veto on the ballot in November. Illinois Gov. J.B. Pritzker made abortion a “fundamental right” in June, signing the Reproductive Health Act into law. The move codifies Roe v. Wade; requires private insurance companies to cover abortion; and repeals laws banning second trimester procedures, requiring husbands’ approval, and prosecuting doctors who provide abortions. New York City allocated $250,000 to the state’s abortion fund, the New York Abortion Access Fund. Many of the patients helped by the fund come from out of state to access abortion services because access in their own states is limited or nonexistent.

September 2019 — Population Connection


In 2017, Population Connection began offering our members support to reach out locally and share information about global population challenges with their own communities. Since then, tabling at Earth Day festivals has become our largest membership-led outreach activity, by far! This year, 125 members hosted tables at 32 events in 30 cities across 16 states! These local Earth Day events serve as the perfect platform for our dedicated members to foster awareness about the many environmental and social impacts of global population growth.

#MyPopNumber This Earth Day, our members chose from a number of activities to engage festival attendees. One of the most successful at driving the population message home proved to be our Population Education program’s #MyPopNumber activity. Visitors entered their birth dates to identify where they fit into our current world population of 7.7 billion. This innovative, interactive activity personalizes just how rapidly human population has grown within each of our lifetimes. Indeed, the global population has more than doubled since the first Earth Day in 1970!


Population Connection — September 2019

Design by Mali Welch

“I connect with …” “I connect with …” was another popular activity, challenging members and visitors alike to share which part of our mission inspires them the most. As an organization working at the intersection of population, environment, empowerment, and rights, there are many ways people can make the “population connection.” Some of our members reported that this activity was the most rewarding part of their experience.

ONE-ON-ONE CONVERSATIONS Member-led information tables, hosted at events like Earth Day festivals, serve as one of the most effective ways we can facilitate one-on-one conversations in a friendly and relaxed environment. Our coordinators work with each member to prepare them to talk about complex population, environment, and human rights issues with visitors. Our support for member-led outreach includes training videos, a summary of frequently asked questions, tips on how to engage visitors, and an overview on all the materials that they can distribute at their booths. Truly, though, the most meaningful benefit our members receive from working with the Membership Relations team is the opportunity to connect and volunteer with other like-minded individuals in their own communities.

We want to say a big thank you to all of our members and volunteers who took the time to help their communities make the “population connection” on Earth Day 2019. Together, they reached nearly 8,000 people and gathered more than 550 signatures on our petition to support the Global HER Act, which calls for a permanent ban of the Global Gag Rule.

Are you ready to help your community make the “population connection”? Reach out to our Membership Relations Coordinators, Rose and Alyssa, at engage@popconnect.org for resources and support. Let’s get started! www.popconnect.org

September 2019 — Population Connection


“Martina” became a nurse with Maya Health Alliance after surviving rape and near-fatal violence as a girl.

GOOD WOMEN Guatemalan Survivors of Gender-Based Violence Transform Their Pain to Purpose Story and photos by Lisa J. Shannon Editor’s Warning: This article contains graphic descriptions of physical and sexual violence against women that may be upsetting to some readers.


artina hated men. She had her reasons. Reasons that went back years, to her earliest memories on the family coffee plantation, skittering out of the way when her father beat her mother, leaving bruises and bloody lips. To her uncle cornering her at nine years old, planting sloppy kisses and yucky hugs, followed by death threats should she ever tell. To her 13-year-old cousin following suit when she was 11 years old— grabbing, kissing, rubbing her all over. Three attempted rapes, each Martina fought off with fists and screams, doing her best to ignore the same “never tell” death threats that followed.  Why does this happen to me? September 2019 — Population Connection 11

She wondered every time she saw a man: Is he going to do the same thing? She says, “And so my fear of men grew. I didn’t want to leave the house. I wanted to just be there, closed up.”

“I had a lot of hate. A lot of hate for men. Including my brothers. I didn’t want to see them. I didn’t want to leave the house. So I spent most of my time shut up inside.”

To pry Martina out of the house, her mother insisted she come to work with her on the finca (plantation). One morning, as Martina made her way across the finca, balancing on her head a heavy woven bag stuffed with coffee service for the workers, she tripped and fell, spilling the bundle of coffee and fixings.

Her mother brought her a sewing machine as a gift. “I began to sew. Little by little, my thoughts began to change. I began to focus on what I can do: washing clothing for money, taking classes at the school, working in a bakery.”

“When I looked up, there was a man.” He was dressed in black, with his face covered, so no one could identify him. He carried a machete. There was no fighting him off. “I screamed and I screamed for someone to help, but no one heard me.” The man shrugged off her cries during the kicking, punching, and rape that left her crumpled on the ground. When he was done, he said, “I’m going to do you a favor and kill you so you don’t have to remember what happened.” Martina recalls, “He lifted his machete. He was going to kill me.” Just then, an armed finca guard came by, pistol in hand, and scared off Martina’s attacker. Martina was so badly beaten, she nearly lost an eye. The guard took Martina home to his wife. “She washed me, gave me clean clothes to wear. Then we cried together.”  In the six months following the attack, Martina had only had one plan: suicide. She tried a variety of methods: starving herself, hanging herself with a rope, roaming the kitchen at night looking for knives (her mother stood guard), begging for a ride to the highway, hoping to be hit by a truck. 

12 Population Connection — September 2019

Eventually, Martina found a job with Wuqu’ Kawoq, or Maya Health Alliance, working on water filtration projects. The organization was founded 12 years ago by a Tulane University PhD student, Anne Kraemer Diaz, to address unique barriers rural, indigenous women face in securing quality health care. Most (80 percent) of this population doesn’t speak Spanish as their first language—there are 21 Mayan languages spoken in Guatemala—yet, medical care is typically only offered in Spanish. Maya Health Alliance, founded to fill that gap in health access, has since grown into the second largest health provider in Guatemala, seeing 20,000 patients a year. All services are offered in patients’ native languages and include sexual and reproductive health care through women’s health clinics. Though Martina was originally hired to work on water filtration projects, her role quickly evolved. “Whenever I went to a house to talk about water, women would tell me: My husband hits me. I don’t want to have any more children.” Her focus shifted, and with specialized training, Martina’s life’s work emerged. “I wanted to work in the clinic as a nurse. I want to help people. Women.” Martina is not unique in what drives her to help indigenous women. Maya

Health Alliance is one of a larger ecosystem of community-based nonprofits in Guatemala, often founded by American expats, but staffed almost exclusively by indigenous Guatemalan women, many of whom are themselves survivors of abuse. Anne Kraemer Diaz says, “With my mostly female staff, I would say at least 50 percent have suffered [incest] in some way, shape, or form, whether a stepfather, an uncle, or a close neighbor.” Their survivorship, channeled into newfound careers as advocates, is not only transforming their own lives, but also those of rural women—and by extension, their families and communities.

Racism and Persistent Indigenous Poverty

Guatemala is still recovering from a 36-year civil war, which ended in 1996. The war included ethnically-motivated torture, forced disappearances, massacres, and other acts of genocide against indigenous Mayan communities, which make up about 40 percent of Guatemala’s population. While overt acts of genocide may be in the past, the reverberations of racism touch nearly every aspect of indigenous community life. Today, the poorest Guatemalans are primarily indigenous. Language is just one of the barriers to health care and poverty alleviation that they face. The poorest quarter of Guatemalans are the most chronically malnourished population on the planet, according to Maya Health Alliance researcher Dr. Caitlin Baird, who specializes in child malnutrition and stunting. Severe malnourishment in the first three years of life, she explains, has permanent effects: anemia, diabetes, high rates of maternal mortality and morbidity later in life. “People have the impression that Guatemalans are short

Above: Maria Ruperta Cosogua Perez, a mobile outreach nurse at WINGS

because of genetics. We know that’s not the case.” She explains: When you don’t get the nourishment you need to grow in your first three years of life, you do end up shorter. You end up with malnourished children who grow up to be sick adults who are less capable of bringing income into the home and are sick more often and they are less productive, and their children end up more stunted. You have this argument that people should just pull themselves up by their bootstraps, which is ridiculous because you’re three. You don’t have any bootstraps. Strong structural barriers keep most indigenous women from accessing contraception and reproductive health care. www.popconnect.org

Geography of the mountainous regions so many call home can prove close to insurmountable: A 17-mile drive can take up to four hours. Nurse Maria Ruperta Cosogua Perez works for WINGS Guatemala, another nonprofit health provider that delivers 92 percent of its services in rural, indigenous communities through two mobile clinics. Maria sets out for work at 3:30am every Monday, in order to make the four-hour journey to the WINGS head office in the colonial town of Antigua. From there, she joins colleagues for a seven-hour journey in the WINGS mobile clinic to a base of operations. For the remainder of the week, they drive eight to nine hours per day to various remote villages to reach residents with health services.

“You have this argument that people should just pull themselves up by their bootstraps, which is ridiculous because you’re three. You don’t have any bootstraps.”

September 2019 — Population Connection 13

seen as people. They are just something to be dealt with.

Machismo at the Root of Gender Inequality

Gender discrimination within indigenous communities begins at birth, with society placing a strong preference on sons over daughters. Karyn Choy, an indigenous nurse with Maya Health Alliance, says, “When it’s a girl, it’s less pay to the midwife. So that’s where our big, big problems start.” The problems only continue. Karyn describes a typical life for a girl child: “You cannot go out. You need to stay home to cook, clean, take care of the children. If you have brothers and sisters, you have to take care of them. You become the second mother.” Making matters worse, young girls who are abused often have nowhere to turn. Mothers, out of fear of escalating violence, do not generally intervene. Dr. Kraemer Diaz explains: Above: A little girl attends a Women’s Justice Initiative training on different types of domestic violence

Mobile clinics that bring health services to rural, indigenous people where they live are an innovative way to reach potential patients who are often reticent to make the long journey to distant clinics, because the promise of care is so precarious. Beyond language barriers, supplies may have run out. Or worse, providers may be abusive. Stories abound of indigenous women being denied reproductive care at government hospitals due to their traditional dress. Doctors have been heard mumbling, We don’t serve your kind. Dr. Kraemer Diaz recalls an indigenous patient who was turned away from a 14 Population Connection — September 2019

health center while in labor, despite having a dangerous condition called placenta previa. She bled to death outside the hospital. Stories of unwanted procedures being performed are also disturbingly common. Dr. Kraemer Diaz says: There have been cases where women get their tubes tied, and they haven’t authorized it. They are told: You’ve had enough. You don’t need any more children. So their tubes are tied after a C-section. That’s all about “their kind” can’t make those decisions. Because indigenous women are not

In Guatemala, there’s no safety net. There’s no way mothers are going to go against their family and say what’s happening, because they’ll be cast out. There’s no options. They’ll be killed. So incest is a real, major problem. It stems from the fact that women are seen as objects. They are not cared for as special human beings, but as objects to be dealt with. And to be dealt with in whatever way men think that should be. Extreme poverty adds additional pressures on girls as they transition to adolescence. With only so many salty corn tortillas to go around, girls as young as 12 or 13 are pressured to get married, just so someone else will feed them. Dr.

Above: Mother and daughter attend a Women’s Justice Initiative training workshop on domestic violence

Baird says, “If you can trade on your sexuality, trade on your femininity in order to get someone to marry you so they will take care of you, that is something you are very much expected to do.” Any chance of gaining agency evaporates in the move to a new family. The young bride is expected to defer to her husband and in-laws in all things: what to feed the kids, when to have sex, and whether (not even when) she can leave the family home. That pattern of control very much extends to contraceptive use as well. An annual survey conducted by WINGS repeatedly finds the average indigenous adolescent girl aims to have two children, www.popconnect.org

beginning at age 26. But, few rural indigenous women are able to access reliable health care, and when they can, they often believe bad things can happen from using contraceptives, which are mired in myth. If you take the pills, you’re going to get really fat and your husband will know. If you get the implant, it’s going to travel through your body and end up in your foot. Do you know what they do in a Pap smear? They take out all of your insides—all of your guts—put them on a table to look at them. And then they put them back inside. They might put something extra, they might leave something out.

“If you can trade on your sexuality, trade on your femininity in order to get someone to marry you so they will take care of you, that is something you are very much expected to do.” September 2019 — Population Connection 15

In practical terms, that means community health workers often have drop-ins at odd hours for patients looking for a quick method of birth control they can hide easily, like a Depo-Provera shot. Enma Rodas Rodriguez is an indigenous community health worker with WINGS. She says, “Sometimes, just when I’ve laid down, there’s a knock on the door. I don’t want to have to go see who it is. And then I think: It’s my responsibility. These are my ladies.” Many of the women Enma sees are living with domestic violence. Sometimes women will say, Please, can you give me the injection fast? He mustn’t know I’m here to get my injection. I just made an excuse I’m going to the mill to grind my corn, so I must get back quickly. Fast, please, my husband doesn’t know I’m here secretly. The husbands think if the woman has the injection, it’s because she has other men in the street. Other men she has a relationship with. Of the 40 women Enma serves, only two come with their husbands. The rest come alone—and secretly.

Above: Enma Rodas Rodriguez, an indigenous community health worker at WINGS

Dr. Rodrigo Barillas, Executive Director of WINGS, says, “A huge percentage of women want to space their children, or not have any more, and they just can’t. They don’t know how.” But none of these forces exact such a heavy toll as the omnipresent force of machismo. Martina explains: Machismo is the biggest issue facing indigenous women’s health. When we say machismo, that means 16 Population Connection — September 2019

men think they are the only ones who have a word, decide what to do. Women have to obey them. If their husbands know they are actively trying to not have children, they would be hit. Experts, from doctors to nurses to violence survivors, echo this refrain. Dr. Barillas says, “It’s the biggest barrier for women trying to access reproductive health services: the men, the partners in their lives.”

Karyn explains that part of the job of health worker is helping cover for the women they serve. The health workers provide extra care for children so they don’t report back to their families about the reproductive care their mothers receive. “We say we are going to weigh the baby or to make sure we are getting glasses for one of the children. In that way [women] can come without letting their children know [the true nature of their visits].”

Unsafe Abortion

With rampant sexual abuse, and contraception so hard to access, it is no surprise

“A huge percentage of women want to space their children, or not have any more, and they just can’t. They don’t know how.”

Above: Dr. Rodrigo Barillas, Executive Director of WINGS

that the teen pregnancy rate is on the rise. Dr. Barillas recalls that in 2017, there were 90,000 pregnancies to girls under age 18. Of those, 5,000 were to girls ages 10–14. He estimates that hundreds of those were to 10-year-olds—the youngest girls in the age range. Community health workers mostly skirt questions about abortion (the procedure is illegal in Guatemala, except when it’s necessary to save a woman’s life). Organizations that provide reproductive health care regularly deal with “phishing” schemes: folks turning up asking after www.popconnect.org

illegal abortion services, presumably to secure evidence to bring legal action against clinics, and shut them down. If a woman asks a clinician about her options for pregnancy termination, she is treated as if she has a psychological disorder. Protocol requires her to be referred to a psychologist. According to Dr. Barillas: There are about 60,000 unsafe abortions in Guatemala every year, and the consequences can be grave. They end up in our national hospitals

with huge infections, or complications. A lot of these women and girls die. You have 60,000 unsafe abortions in our country. So you are going to have 60,000 patients who have consequences from that. Dr. Ana Michelle Dubon Estrada, Medical Director at WINGS, previously worked as an OB/GYN in public hospitals. In that role, she treated a tiny 13-year-old rape survivor who got an infection during childbirth that turned septic. The girl died in her arms after giving birth. She treated a 16-year-old

September 2019 — Population Connection 17

Above: Dr. Ana Michelle Dubon Estrada, Medical Director at WINGS

who impaled her uterus with nails and umbrella spokes during a self-administered abortion. But the patient who haunts her most is the 13-year-old girl who begged her for an abortion, which Dr. Dubon Estrada refused to perform due to legal constraints. The girl hung herself the next day.

The “Good Woman”

For women and girls caught in a web of compounding constraints, there is a widely celebrated alternative to agency, one they are expected to embody: the “good woman.” Dr. Kraemer Diaz articulates this cultural ideal: To be that indigenous woman, she’s head-to-toe in typical dress. She’s 18 Population Connection — September 2019

usually a weaver. She cooks well. She’s ready to do whatever it is that needs to be done: taking care of her husband, cooking, and cleaning. And she’s smiling. But, thanks to the dogged advocacy efforts of local women’s rights groups, expectations around what women should quietly tolerate are beginning to change. In 2008, Guatemala passed the landmark Law Against Femicide and Other Forms of Violence Against Women. The law criminalizes psychological, sexual, and economic forms of violence, in addition to physical violence, and includes as one form of sexual violence “denying [a woman] the right to use contraceptive methods, whether natural or hormonal.”

For women and girls caught in a web of compounding constraints, there is a widely celebrated alternative to agency, one they are expected to embody: the “good woman.” Of course, these laws only work if the women they are intended to protect know about them, and know how to use them. That’s where community advocates come in, often drawing on their own experiences to guide other women. Armed with the backing of law, advocates are revising what it means to be a “good woman.” Rural advocates aim to break open the barriers of isolation, oppression, and abuse to create healthier women, families, and communities.

Take Karyn. Her dream was to become an attorney. Following her studies at a community college in the United States, she returned to Guatemala to pursue her law degree. She became a community leader on domestic violence. “Traveling, telling people about violence. The way to report when you get hit: go to police, do this, do that. You’re going to be fine. Don’t worry, the laws are on your side.” Things changed when she got married and had her first baby at 24 years old. Her husband insisted she quit law school to care for the baby, so Karyn dropped out. It was two years of psychological violence: You are old. You’re getting fat. You’re not beautiful anymore. I have to look for someone else. The first time I got hit, it was my birthday, and my first day at Maya Health Alliance—hit today, and tomorrow I had to go to work at my new job. But all those internal tapes about being a “good woman” and having the “right family” kept her from leaving. “I didn’t tell anything to anybody. Put on a smiling face.” Three months later, it happened again. Harder. This time he drew blood. Choked her. Took her keys. Locked her in the house. Then he mocked her, Karyn, teaching women! Ha, look at you! Can’t you see yourself! “When he said that to me, I woke up.”  She hid her Maya Health Alliance phone so her husband wouldn’t confiscate it, and later called a friend, who advised her, “This is the second time. The third time, he is going to kill you.”  Karyn went to the police and filed a denuncia (official report). The next day, www.popconnect.org

Above: Girls practice needlework outside a Women’s Justice Initiative workshop on domestic violence

the police came to escort her safely from the home. Her husband begged her to stay, but the old lines about being a “good woman” didn’t stick. “I told him, No. I’m taking my son. I’m taking my things. And I’m leaving. And I took everything. I took our TV.” Years later, her now-ex husband still blames her: You went to police. You told them what happened. Why did you do that

to me? It was nothing, and I had to go to jail! You are a devil! She recites the standard response she gives him: Okay, I’m a devil. You know what? It wasn’t right, what you did to me. And I did it because you have to learn you can’t hit anybody. Even if you get married again, you don’t get to hit anybody. September 2019 — Population Connection 19

Now, Karyn is back in nursing school, and working full time for Maya Health Alliance. She uses her hard-won wisdom to counsel her patients.

Martina says, “She didn’t really know what was happening. Her dad treated it like it was normal, so she thought it was normal.”

It’s not easy to say, Okay, I have to leave. Especially with five or six or seven kids. I just had one. It was easier I think. Everyone says you are guilty. Why are you leaving your family? Society judges you.

When Martina gave her the news that she was pregnant, Laura had to ask Martina through her tears, “Where is the baby going to come from?”

After nursing school, Karyn dreams of returning to law school. “My thought before was to help women. I knew I could do many things, counseling women.” Martina describes how helping women in her community has changed her life: I lost all of the bad vibes about if I could or couldn’t do this. I just do it. As I’m helping them, I’m helping myself. Now my brothers and father, they’re nervous around me. I’ve lost my fear. I don’t want to die. I want to live. I love this work. I identify with the women I’m working with. Women may come for a Pap smear or family planning. Martina says, “They get those things. But afterwards, they ask questions. That’s when I get their stories.” Many of those stories are truly tragic. “Laura,” 14 years old, came to the clinic with stomach pain. When Martina asked about a boyfriend, Laura said, “I don’t really know what that is. But, excuse me, I had blood a few days ago.” The blood came following a late night incident. Her abusive and philandering father, who was drunk, brought home an equally drunk friend and told Laura, “In all things, you have to please my friend.”

20 Population Connection — September 2019

Martina smelled an infection, and insisted that Laura’s reluctant mother take her to the hospital. Ultimately, Laura miscarried. But, per the 2008 Femicide Law, any pregnancy to a girl age 14 or younger is automatically considered to be the result of rape, and it triggers a mandatory investigation. The father’s friend went to jail.  Laura has come back to the clinic to let Martina know there is no more hitting in the home because of the open legal case. If there is another report, the father will go to jail along with his friend. “Roxana” began coming to Martina’s clinic for surreptitious Depo-Provera shots, often covered in bruises, sometimes on her face, sometimes on her arms. At first, when Martina asked Roxana about the injuries, she would simply say she fell. Martina said, “It’s only when you gain trust they tell you what’s happening in reality.” Over the years, Roxana opened up. When Roxana married, her husband told her his ground rules: I have the right to be with anyone I like. You can’t be with anyone but me. You are supposed to be a ‘woman of the house.’ You can’t go out with friends or with family.  Growing up, her mother wasn’t allowed an opinion. Her father looked for a husband for Roxana—someone who would

“It’s not easy to say, Okay, I

have to leave.

Especially with five or six or seven kids. I just had one. It was easier I think. Everyone says you are guilty.

Why are you leaving your family? Society judges you.”

give him the most land in exchange for her. She told Martina, “My father sold me.” Roxana thought she had to obey. If her husband beat her, she believed, it was because she did something bad. That needed to be corrected. She would say: Look, Ms. Martina, my husband hits me. But it’s because I do bad things in

the house. It’s to instruct me. I hope that in the future I won’t mess up again, and he won’t need to hit me anymore. Martina explains, “She felt like she had to stay in the house because her husband was the one who paid for things.” Martina counseled her with a steady stream of messages: Men are not the only ones who can work. We can too. We can be the head of the family. Look: Women work. We iron, we keep the house, we watch the children. So, yes, of course women can work. We already work harder than men anyway!  Roxana realized she has rights. And so she finally thought to herself: If he hits me again, I’m going to get a denuncia. When her husband was about to hit her, she would say to him, I know there’s a law that protects women. So if you hit me, I’m going to denounce you. It’s been six years. Roxana still comes to the clinic. She works, embroidering and selling handbags. She’s still with her husband, and he doesn’t hit her anymore. She has the contraceptive implant, so there have been no more children. In six years, she hasn’t gotten pregnant. Martina says, “I always tell them: You’re very, very important. It’s important to value women as well. We are not objects. We are the treasure of the hearth.” 

Standing Up to Intimidation

Through quiet conversations during Depo-Provera shots, frontline health care workers are redefining just what makes a “good woman.” They’re helping women scale structural barriers, standing by them as they reclaim life-affirming choices, whether it be Pap smears for themselves or jail terms for their rapists. www.popconnect.org

Above: Claudia, a community outreach worker at Women’s Justice Initiative

But breaking these norms doesn’t come easy, nor does it come without risk. Like so many indigenous women working in community outreach, Claudia is

a survivor. She dropped out of school when she was nine, after being molested by her teacher. She then became a recluse for most of her teen years.

September 2019 — Population Connection 21

Above and below: Girls attend a Women’s Justice Initiative workshop on domestic violence with their mothers

But today, things could not be more different. Several years ago, Claudia was recruited to community-based nonprofit Women’s Justice Initiative by fellow indigenous woman Elvia Raquec, who serves as Programs Director. Founded by American attorney Kate Flatley, Women’s Justice Initiative is staffed almost exclusively by indigenous women, from the attorneys to the psychologists to the community outreach workers like Claudia. Together, they aim to end violence against women and girls in rural Guatemala. Elvia says: The problem of violence is not cultural. It’s due to lack of education, lack of opportunities. And in many cases, lack of access to justice. In 22 Population Connection — September 2019

most cases, information is not available in native languages. This is why violence continues. Frontline advocates like Claudia bridge that gap in knowledge, opportunities, and services, through prevention education workshops on topics like early marriage, domestic violence, legal services, and engagement with men and

“The problem of violence is not cultural. It’s due to lack of education, lack of opportunities. And in many cases, lack of access to justice. In most cases, information is not available in native languages. This is why violence continues.” www.popconnect.org

Above: Elvia Raquec, Women’s Justice Initiative Programs Director

boys. Claudia has become such a trusted confidante in her village, she had to set up an outdoor waiting area on her family compound, nestled amongst potted plants and frolicking kittens, for the many women who stop by for a chat about troubles at home.

sweet natured helper, Blanca was often asked by folks around town to do stacks of their laundry or clean their homes for little thanks and no pay.

One day, Claudia arrived home to find a neighbor, “Sandra,” sitting in her front yard, waiting for her. Claudia had grown up knowing Sandra’s daughter, “Blanca,” who has an intellectual disability. Ever a

Blanca, now 20 years old, was six months pregnant. A local teen had been sneaking into the family home to have sex with Blanca when her parents were at church. Sandra came to Claudia, hoping she could help force the boy to marry Blanca. 

September 2019 — Population Connection 23

“I want to eliminate machismo. I want to help women. I want the following generations to see change. I want to see violence against women end. I want to set the example.”

Claudia saw things differently. She knew Blanca was not mentally capable of consenting to sex. Under Guatemalan law, having sex with a severely intellectually disabled person is considered rape. Claudia advised Sandra to pursue a criminal case. Instead, Sandra threatened the assailant’s family with criminal charges unless he agreed to marry Blanca, citing Claudia as

24 Population Connection — September 2019

the force behind pressing charges. This is when the death threats began. One day, when leaving her clinic, Claudia spotted the boy’s father across the street, swinging a machete menacingly. Claudia escaped him by dashing out of her clinic and quickly boarding her bus. Another day, the boy’s father lurked in cornfields on Claudia’s route home, waiting for her. When she passed, he followed

close behind, dragging and scraping his machete on rocks. When she made it safely home, he lingered a long time up the hill, watching her. With some digging, Claudia learned from other health care workers that the family had recently moved from a neighboring village. The father had been raping his own daughter repeatedly since she was 13. His death threats toward Claudia were aimed at preventing a

Opposite and above: Indigenous women (and their children) attend a Women’s Justice Initiative training workshop on different types of domestic violence

police investigation that could uncover that he had impregnated his daughter. Claudia never could get Blanca’s family to press charges, but the death threats and intimidation didn’t slow her down. She describes her hopes for the future: I want to eliminate machismo. I want to help women. I want the following generations to see change. I want to see violence against women www.popconnect.org

end. I want to set the example. I want to show girls there’s more than getting married. They should enjoy their lives.

Change Starts Here

Martina used to ask herself, Why does this happen to me? She used to want to die. Her story, and those of the other advocates working to end violence against women in Guatemala, is a testament

to the power of culturally appropriate community outreach and a trusted ear. Martina, Karyn, Enma, and Claudia are good women—women who have overcome more than anyone should have to endure, and who still have compassion and care to give others in situations similar to the ones they’ve survived. In fact, they aren’t just good women— they are magnificent women.

September 2019 — Population Connection 25

Washington View

Show Me the Money: Appropriations Season Underway By Stacie Murphy, Director of Congressional Relations

Major Victories for Family Planning in Funding Bill

In mid-May, the House Appropriations Committee met to consider the FY 2020 State Department/Foreign Operations spending bill, which funds U.S. international family planning programs. By every measure, the underlying bill was a marked improvement over previous years. It called for a minimum of $750 million for bilateral international family planning programs, a robust increase over the most recent enacted level of $575. The committee request was a dramatic rebuke of the Trump administration’s pathetic request of $237 million. The spending bill also earmarked $55.5 million for the U.S. contribution to the United Nations Population Fund (UNFPA), a $23 million increase over the most recent level. More importantly, the bill removed the prohibition on funding that had been included in previous years’ House bills. The new UNFPA funding, however, even if enacted, can still be withheld by the White House, due to a provision known as the KempKasten amendment. During debate on the bill, Rep. Chuck Fleischmann (R-TN-3) offered an amendment to strike the contribution 26 Population Connection — September 2019

to UNFPA and reinstate the ban on U.S. funding to the organization. The Fleischmann amendment was defeated 23–29, with all Democrats present voting “no” and all Republicans voting “yes.”

Rep. Andy Harris (R-MD-1) offered an amendment to strip the Global HER Act language from the spending bill. His amendment failed, 22–29, along party lines.

Additionally, the bill included the operative language of the Global Health, Empowerment, and Rights (HER) Act (S. 368/H.R. 1055). Sponsored by Sen. Jeanne Shaheen (D-NH) and Rep. Nita Lowey (D-NY-17), the Global HER Act would permanently repeal the Global Gag Rule. Its inclusion in the appropriations bill is an enormous victory.

The spending bill was ultimately approved by the committee by a vote of 29–23, also along party lines.

The Global Gag Rule, a fixture of every Republican presidency since Ronald Reagan—and dramatically expanded under Donald Trump—cuts off U.S. aid to any overseas NGO that uses its own funds to offer abortion services, referrals, or counseling to its patients. A recent study, published in The Lancet, found that by cutting off funding for contraception and other basic health care programs, the Global Gag Rule causes the incidence of abortion—particularly unsafe abortion—to go up. In fact, the researchers found that abortion incidence increased by 40 percent in the most affected countries during George W. Bush’s Global Gag Rule.

In mid-June, the bill came to the full House floor as part of a “minibus”—a package of five separate funding bills bundled to be debated and passed together. Floor debate gave anti-family planning members a second opportunity to attempt to remove provisions they opposed. Rep. Debbie Lesko (R-AZ-8), along with 14 Republican cosponsors, offered an amendment to eliminate the family planning funding requirement. It failed 188–225. All Democrats present voted against the amendment, with two exceptions: Rep. Dan Lipinski of Illinois (3rd district) and Rep. Collin Peterson of Minnesota (7th district). All Republicans present voted in support of eliminating the family planning funding requirement. At the time of our deadline, the Senate had not yet begun work on its version of the bill. However, with two profamily planning Republicans on the

Appropriations Committee (Sens. Susan Collins of Maine and Lisa Murkowski of Alaska), there may be opportunities here to advance our policy and funding goals that simply weren’t available in recent years, when family planning opponents controlled the House.

ECHO Trial Results: a Relief, and a Warning

Back in 2011, a study from the University of Washington set off alarm bells among family planning and HIV/AIDS groups when it found that women who used hormonal contraception—specifically the Depo-Provera injectable contraceptive—were at an increased risk of contracting and/or spreading HIV. The difference wasn’t small: The study indicated the risk for Depo users might be twice as high as for users of nonhormonal methods. The 2011 study also found higher rates of HIV transmission among pill users, though the participant sample was too small for the researchers to be confident about the implications. The pill remains one of the most popular forms of contraception in the world, while Depo is one of the only reliable methods available to people who don’t want a partner to know they’re using contraception. If the study’s finding was


Appeals Court Upholds Domestic Gag Rule

accurate, it would seriously complicate the picture for millions of people. The ECHO (Evidence for Contraception Options and HIV Outcomes) trial was intended to provide a definitive answer to the question. The trial, involving more than 7,800 women across four countries—Eswatini (formerly Swaziland), Kenya, South Africa, and Zambia— tested three contraceptive methods (a hormonal implant, an injectable contraceptive, and the copper IUD). The results, released in late May, were a tremendous relief to family planning advocates: There was no difference in HIV infection rates among users of the tested methods. The study did, however, have one alarming finding. Despite extensive counseling and the use of PREP (pre-exposure prophylaxis) medications, rates of HIV acquisition were unacceptably high across the study population, highlighting the continuing need for efforts to fight the epidemic. The ECHO trial highlights the importance of serious, careful science in questions of public health. It also throws into sharp relief the haphazard way the United States approaches such questions, especially when it comes to reproductive health.

In our last issue, we reported that a federal court in Washington state had delayed Trump’s Domestic Gag Rule nationwide. The rule cuts off Title X funds to family planning providers that offer abortion services or referrals, along with several other measures that would undercut the program. Trump’s department of Health and Human Services appealed the ruling, and on June 20, a three-judge panel from the 9th Circuit Court of Appeals reversed the lower court’s ruling, lifting the injunction and allowing the rule to go into effect immediately. The National Family Planning and Reproductive Health Association, one of several plaintiffs challenging the rule, filed an emergency motion asking that the entire 9th Circuit Court of Appeals reconsider the decision. It did, on July 11, but rather than reject the panel’s ruling, the full court affirmed it. Parts of the rule—the gag on abortion referrals, for one—are already going into effect, while others will be phased in over time. For now, the Trump administration is winning this battle, but advocates have vowed to continue the fight.

September 2019 — Population Connection 27

Field & Outreach

Summer of HER Activist Institute By Ameya Sanyal, Stanback Grassroots Outreach Intern


n June, we kicked off the 2019 Summer of HER (Health, Empowerment, and Rights) Activist Institute. We’re thrilled to be spending the summer developing activists who can lead the #Fight4HER across the country. Fellows, under the direction of our standout field organizers, will spend the summer learning essential organizing skills (visibility, petitioning, event organization) in the classroom, and out in the field where the action is! We have 72 #Fight4HER fellows across 10 cities in our eight target states. In addition to hitting the ground and mobilizing people against Trump’s Global Gag Rule, we’re hosting 10 summits in our 10 cities, which will bring together experts and activists to talk about how best to defend reproductive health and rights. Despite continued attacks by the Trump administration, we’re not backing down on our commitment to defend reproductive freedom. We are tirelessly working to end the Global Gag Rule, repeal the Helms Amendment, restore funding to UNFPA, and ensure continued, robust investment in international family planning. We’re building on two years of momentum—and we’re far from done.

ie #Fight4HER Wisconsin organizer Kat Wade rallied a crowd of over 450 to #StopTheBans at the State Capitol in Madison.

#Fight4HER fellows in Tucson spoke out for reproductive health and rights.

O ur Phoenix Su mmer of HER team gathered for a group phot o.

28 Population Connection — September 2019

Fellows in Las Vegas we re fired up for the first day of the Summer of HER Activist Institute!

bright and early to Phoenix fellows were up and engage people collect petition signatures rs market. at a local weekend farme


ur fellows and volunteers have been garnering enthusiasm in communities across the country at local farmers markets and community festivals. In the months since the Summer of HER kicked off, our activists have collected over 7,000 petitions in support of the Global HER Act. During Pride month, our #Fight4HER teams supported and celebrated the LGBTQ+ community at pride festivals throughout the country.

o, e in Columbus, Ohi At Stonewall Prid d an s ile sm all re ws we #Fight4HER fello s ared their message sparkles as they sh s. ht rig uctive supporting reprod


Each week, com munity members in Alle ntown, Pennsylvania, ra lly outside Sen. Pat Toom ey ’s office. #Fight4HER ac tivists joined other grassroots groups in a #StopTheBans rally.

Our Denver team brought the #Fight4HER—and the photo booth—to Denver Pride.

In Las Vegas, fellows tabled at First Friday, a community arts festival attended by 15,000–20,000 people. Through an interactive display, fellows asked the community: What does reproductive freedom mean to you?

Summer of HER fellow Jennifer German put her petitioning training into action at the first Dane County (WI) farmers market of the summer.

September 2019 — Population Connection 29

Teaching About a Rapidly Urbanizing World PopEd

By Abby Watkins, Population Education Fellow

O people.

ne in 14 people worldwide lives in a “megacity”—a city with a population of over 10 million

Megacities present unique opportunities and challenges: They often have more public transit and access to services such as health care and education, but may struggle to manage waste, sanitation, and the consequences of sprawl. Urbanization will be one of the most seismic shifts in population to occur over the coming decades. Urban residents first comprised a majority of the global population in 2007, and the UN estimates that by 2050, 68 percent of all people will live in urban areas. The sustainability of urban centers depends on how cities evolve. Urban populations consume more food and energy than rural populations do, but their fertility rates are also lower, meaning that urbanization contributes to slowed population growth. With the number of megacities projected to grow from 33 in 2019 to 43 in 2030, they are poised to have an immense impact on population dynamics and resource trends worldwide.

30 Population Connection — September 2019

A Tale of Three Megacities

PopEd’s high school curriculum, Earth Matters, includes a unit that considers the rise and ramifications of urbanization. The lesson plan “A Tale of Three Megacities” invites students to explore Lagos, Tokyo, and São Paulo—three cities with unique challenges and advantages in an increasingly urbanized world. The lesson begins by asking students to consider two maps that show the world’s urban population by country for 1960 and 2016. Individually, and as a class, students analyze the trends they observe over more than 50 years of urban growth. The concept of “megacities” is introduced with an online interactive map from The Economist, “Bright lights, big cities.” This resource is a visualization of the growth of cities from 1950 through 2014 and then projected out to 2030. After playing the visualization for students, the teacher identifies Lagos, Tokyo, and São Paulo on the map. Lagos, Nigeria, is the largest city in Africa and one of the most rapidly growing megacities. Tokyo, Japan, is the largest city in the world, though it’s projected to lose that status as Japan’s aging population continues to shrink. São Paulo, Brazil, is the largest city in the Western Hemisphere and home to nearly a tenth of Brazil’s population.

Students then divide into three groups, one for each city, and visit “City Stations” that the teacher has created from resources provided in the lesson plan.

The City Stations

The City Stations each contain seven different items for students to examine to learn more about their assigned city. Items include charts, videos, articles, and photos, all of which illuminate different realities about their respective megacities. The following are excerpts of some of the City Station items, along with student assignments.


A population pyramid for Nigeria enables students to make predictions about Nigeria’s future demographic dynamics and how they will impact Lagos. A news article reports the collapse of a floating school in the waterfront slum of Makoko and describes how the ingenuity of the school stood in opposition to city officials’ characterization of the slum as unlivable. Students consider why a floating school might uniquely meet the needs of Makoko and what its collapse means for the future of the settlement.

A line graph shows the African countries with the highest GDPs and each one’s GDP growth from 2000 to 2013, along with a short explanation of the growth of Lagos’s economy. Students consider what sectors of the economy contributed to the growth of Lagos’s middle class.


A bar graph compares transportation use in Tokyo to that of other cities such as Seoul and London. Students consider what makes Tokyo an outlier in public transit and how its low use of personal vehicles affects Tokyo’s carbon emissions. A video depicts how tiny private rooms in Internet cafés have become home for thousands of residents who can’t afford traditional accommodations in the city, even though many of them are employed full-time. Students contemplate the circumstances that might lead someone to live in this type of non-formal, temporary housing. An article describes the urban “heat island” effect in Japan’s cities. Students explain this phenomenon and analyze how this increase in temperature might be correlated with an increasing number of storms in the region.

Favela do Paraisópolis, São Paulo, Brazil | Fernandes/istockphoto.com

São Paulo:

A photo (above) displays two adjoining neighborhoods—an area of wealthy high rise apartments next to a sprawling, impoverished favela. Students consider how daily life likely differs between the two neighborhoods.

A map shows the percent of GDP that is produced by each of Brazil’s federative units. Students assess what GDP tells us about a country or state and describe what the map indicates about São Paulo’s economy. An article recounts how São Paulo banned outdoor advertising such as billboards, and how removing these ads revealed previously hidden favelas, illuminating structural inequality in the city. Students decide whether making poverty more visible does more good or harm.

After students finish examining all of the items at their respective City Stations, they form new groups of three with one person representing each city. Together, they compare and contrast the megacities and discuss the positives and negatives of urbanization demonstrated by each one.

The full lesson plan is part of the Earth Matters Urbanization Unit and is available from populationeducation.org. www.popconnect.org

September 2019 — Population Connection 31

Reprinted by permission. ©Steven G Artley • artleytoons • ALL RIGHTS RESERVED


32 Population Connection — September 2019

Editorial Excerpts

Los Angeles, CA

Salt Lake City, UT

For half a century, the federal Title X family planning program has offered a lifeline to underserved urban and rural communities, funding clinics that provide contraception, breast exams, screening for sexually transmitted disease and a measure of basic healthcare to 4 million people a year. Some of those clinics also provide abortions — but never with Title X dollars.

Being truly pro-life means actively working to provide women—and men—with choices, choices given to individuals that lead to a society with many fewer unwanted pregnancies, fewer women who have to face those pregnancies alone, with no support, no prospects, no other way out.

But providing an abortion is entirely different from providing information to a pregnant woman about her options—including, if she wants it, a referral to an abortion clinic. For nearly two decades, providers were required to counsel pregnant patients, when they asked, on all their options, including abortion, without steering them to one or another. If a patient did ask for an abortion referral, the provider had to give her one. More recently, under the Affordable Care Act, healthcare providers in general have been required to offer all relevant information to patients. That certainly seems like it would include providing information on all options to pregnant women. But under the new Trump administration rule, healthcare providers no longer must provide pregnancy counseling (although they may, as long as the counseling is neutral). And even though they are permitted to discuss abortion as part of that counseling, they are prohibited from providing referrals to abortion providers. The most that Title X providers are allowed to do for someone who asks for a referral to an abortion clinic is offer the patient a list of comprehensive primary healthcare providers. Some of the facilities on the list—“but not the majority,” according to the rule—can also provide abortions. Or none of them could. But the provider can’t point out which facility on the list offers abortions. The rule is ludicrously restrictive. It’s also ludicrous to conclude, as the 9th Circuit did, that providing an abortion referral is tantamount to providing an abortion. It’s not. – June 29, 2019 www.popconnect.org

It means giving women the choice of low-cost—free would be better—safe and effective forms of contraception. It means offering both genders complete and judgment-free sex education at age-appropriate levels. It means giving women the choice of living in a society where their male contemporaries are raised to respect women, not treat them as objects for sexual gratification, not abandon them or, worse, coerce them into having abortions. It means the choice of living in a culture where tools of death don’t have more constitutional protections than women’s bodies. It means the choice of living somewhere where laws governing reproductive physiology are not made by people who are astoundingly, if not willfully, ignorant of the subject. It means voting out lawmakers who really seem to think that women can fend off pregnancies created by “genuine rape,” that ectopic pregnancies can be surgically repositioned, that the vibration of fetal cells at six weeks’ gestation constitutes a “heartbeat.” The goal of the current wave of state laws seeking to prohibit abortion in virtually all cases is not to reduce abortions. It is not to “respect life.” It is to be cruel, to be coercive, to excite a political base, to pretend to solve a public health problem with law enforcement tools, to further boost mass incarceration, to Make America Great Again by making women legally inferior again. – May 22, 2019

September 2019 — Population Connection 33

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Population Connection, September 2019  

Population Connection, September 2019