Mothers We Could Save: Family Planning Is Just As Essential For Humans As For Horses
Here’s a Mother’s Day thought: There’s a way to save many of the world’s 350,000 women who die in childbirth each year. But it’s very controversial, for it’s called family planning.
Republicans in Congress have gone on the warpath this budget season against family planning programs at home and abroad. To illustrate the stakes, let me share a Mother’s Day story about a pregnant 30-year-old Somali woman named Hinda Hassan.
Ms. Hassan lived in a village near this remote town of Baligubadle in Somaliland (a self-ruling enclave carved from Somalia). She never used family planning, for none is available within several days’ walk. When her eighth child was still an infant, she became pregnant again.
“I was happy when she became pregnant,” said her husband, Muhammad Isse, who tends a herd of 13 camels with his family. “I was very happy, because I had faith in God.”
When Ms. Hassan went into labor, she was looked after by two traditional birth attendants, both of them unschooled, untrained and unequipped. “We try to wash our hands with soap and water,” one of them, Amina Ahmed, told me. “But sometimes we don’t have soap. And if there is no water, we rub our hands in the sand to clean them.”
Ms. Hassan’s labor did not go well. After 11 hours, her husband paid a man with a pickup truck $50 to drive her three hours to the clinic here in Baligubadle. The clinic couldn’t help Ms. Hassan and sent her on another two-and-a-half-hour bone-rattling drive in the back of the pickup to the Somaliland capital of Hargeisa. Shortly after Ms. Hassan arrived at the Edna Adan Maternity Hospital (mentioned in my last column), she died.
Her death was infuriatingly unnecessary — and I felt doubly saddened when I met some of her eight orphans.
There are any number of ways that Ms. Hassan’s life could have been saved. She had an off-the-charts hemoglobin level of just 4, reflecting a stunning level of anemia. A trained midwife could have given her a deworming pill and iron supplements early in the pregnancy, addressing that anemia and strengthening her. Later, Ms. Hassan developed a complication called eclampsia that would have been detected if she had had pre-natal care.
Yet maybe the simplest way to save her life would have been contraception. If Somali women had half as many pregnancies (they now average six births), there would be only half as many maternal deaths. But modern contraception doesn’t exist in this part of Somaliland.
“The only method of family planning we have is breast-feeding,” said Nimo Abdi, the midwife at the clinic here, noting that breast-feeding reduces the likelihood of a new pregnancy. Ms. Abdi thinks that some local people would accept modern contraceptives if they were available.
“If I had injectables and condoms, people would accept them,” she said. “They would want them.”
I wonder if that isn’t a bit optimistic; in a place like this, family planning requires much more than just handing out contraceptives. Ms. Hassan’s husband told me that he had never heard of contraception, and he sounded wary of the idea.
Many people in poor countries want large families, partly to ensure that some will survive despite high death rates. Or a woman may distrust contraceptives or fear her husband’s reaction if she is caught using them.
By United Nations estimates, 215 million women worldwide have an “unmet need” for family planning, meaning they don’t want to become pregnant but are not using effective contraception. The Guttmacher Institute, a widely respected research organization, estimates that if all the unmet need for contraception were met, the result would be 94,000 fewer women dying of pregnancy complications each year, and almost 25 million fewer abortions each year.
Greater access to birth control would also help check the world population, which the United Nations warned a few days ago is rising more quickly than expected. The U.N. now projects the total population in 2100 will be 10.1 billion.
Yet this year, Republicans in Congress have been trying to slash investments in family planning. A budget compromise last month cut international family planning spending by 5 percent, but some Republicans are expected to seek much bigger cuts in future years.
If they succeed, the consequences will be felt in places like this remote Somali town. Women won’t get access to contraceptives, and the parade of unwanted pregnancies, abortions, fistulas, and mothers dying in childbirth will continue.
Ah, but there was one Republican-sponsored initiative for family planning in Congress this year. It provided contraception without conditions — for wild horses in the American West. It passed on a voice vote.
Maybe on Mother’s Day, we could acknowledge that family planning is just as essential for humans as for horses.
By: Nicholas D. Kristof, Op-Ed Columnist, The New York Times, May 7, 2011
Are There Any Pro-Choice Republicans Left In The House?
Yes, America, there are pro-choice Republicans. But after this week, there’s some question about whether are any left in the U.S. Congress.
H.R. 3, the “No Taxpayer Funding For Abortion Act” that passed the House May 4 is not likely to become the law of the land. But the fact that it passed the House with unanimous Republican support means the pro-life members of the party, which includes all the House leadership, can tout their attachment to social issues, even after the supposedly fiscal-first tea party movement helped take over the GOP last year.
For pro-choice Republicans, the vote means embarrassing questions. Basically every pro-choice group says H.R. 3 is an anti-abortion bill that goes far beyond the government’s current prohibitions on abortion funding and actually raises taxes on women who want to seek abortion coverage in their private insurance plans.
That’s a double-whammy for pro-choice Republicans. One, raising taxes under any circumstances is a no-no for anyone in the modern GOP. And, two, the bill has been cast as the biggest assault on abortion rights in years.
Voting against such a measure, then, would seem like a no-brainer. Except it wasn’t. None of the about a dozen House GOP members of the Republican Majority For Choice PAC considered as allies, voted against H.R. 3. In fact, all of them voted yes.
“We opposed the bill, we considered it an anti-choice, big government intrusion and politically we think it’s a bad move for the Republicans to keep focusing on this,” K.R. Ferguson, executive director of the PAC told TPM.
Still, she says that she’s not prepared to say the members who voted for it have given up their pro-choice credentials. She pointed to the refusal of some Republicans to sign on to the House plan to defund Planned Parenthood as the kind of thing that will keep the PAC’s endorsement coming.
“I would not say we would stop supporting any of the members who took this vote,” Ferguson said. She said that though it’s hard to rectify being pro-choice and voting for H.R. 3, support from her PAC isn’t “an all or nothing” prospect.
There are still Republicans who run as pro-choice members, despite the fact that the party in the House is about as far from supporting a woman’s right to choose as it could possibly be these days.
Rep. Robert Dold (R-IL) touted his endorsement from Ferguson’s PAC back in 2010. Ferguson said he might get it again, despite his vote for H.R. 3. Dold’s office didn’t respond to a request for comment.
Though repeatedly expressing her extreme disappointment with the vote, Ferguson suggested Dold and his fellow pro-choice Republicans really had no choice.
“The extreme who was pushing this bill did a masterful job of spinning it as a no taxpayer fundings for abortion [measure] and putting these members in an almost impossible position,” she said. “We don’t like it, we will continue to call on our members to try to educate them” on the truth of the bill.
Illinois Republican Rep. Judy Biggert, a past co-chair of the House pro-choice caucus, says that her vote for H.R. 3 was completely consistent with her pro-choice views.
“Rep. Biggert is pro-choice. She supports a women’s right to chose, but she does not support public funding for abortion,” spokesperson Zachary Cikanek told TPM. “Abortion is a private decision, and it should be paid for with private dollars – without government involvement. That’s why she voted for H.R. 3.”
Cikanek noted that Biggert “has stated publically that she thinks Congress should be keeping its attention focused on spending and jobs, and not spending its time locked in debate on divisive social issues.”
Not all pro-choice advocates are willing to accept that kind of answer. NARAL President Nancy Keenan told TPM that a pro-choice vote for H.R. 3 is a political oxymoron. Though her group is non-partisan, NARAL hasn’t endorsed any Republicans serving in the current House, despite the fact that members like Biggert claim to be supporters of the cause.
“No member of congress can vote for this egregious bill and be considered pro-choice,” Keenan said. “Bottom line.”
By: Evan McMorris-Santoro, Talking Points Memo, May 7, 2011
“Crowing” And The Torture Apologists
The killing of Osama bin Laden provoked a host of reactions from Americans: celebration, triumph, relief, closure and renewed grief. One reaction, however, was both cynical and disturbing: crowing by the apologists and practitioners of torture that Bin Laden’s death vindicated their immoral and illegal behavior after the Sept. 11 attacks.
Jose Rodriguez Jr. was the leader of counterterrorism for the C.I.A. from 2002-2005 when Khalid Shaikh Mohammed and other Al Qaeda leaders were captured. He told Time magazine that the recent events show that President Obama should not have banned so-called enhanced interrogation techniques. (Mr. Rodriguez, you may remember, ordered the destruction of interrogation videos.)
John Yoo, the former Bush Justice Department lawyer who twisted the Constitution and the Geneva Conventions into an unrecognizable mess to excuse torture, wrote in The Wall Street Journal that the killing of Bin Laden proved that waterboarding and other abuses were proper. Donald Rumsfeld, the former defense secretary, said at first that no coerced evidence played a role in tracking down Bin Laden, but by Tuesday he was reciting the talking points about the virtues of prisoner abuse.
There is no final answer to whether any of the prisoners tortured in President George W. Bush’s illegal camps gave up information that eventually proved useful in finding Bin Laden. A detailed account in The Times on Wednesday by Scott Shane and Charlie Savage concluded that torture “played a small role at most” in the years and years of painstaking intelligence and detective work that led a Navy Seals team to Bin Laden’s hideout in Pakistan.
That squares with the frequent testimony over the past decade from many other interrogators and officials. They have said repeatedly, and said again this week, that the best information came from prisoners who were not tortured. The Times article said Khalid Shaikh Mohammed, who was waterboarded 183 times, fed false information to his captors during torture.
Even if it were true that some tidbit was blurted out by a prisoner while being tormented by C.I.A. interrogators, that does not remotely justify President Bush’s decision to violate the law and any acceptable moral standard.
This was not the “ticking time bomb” scenario that Bush-era officials often invoked to rationalize abusive interrogations. If, as Representative Peter King, the Long Island Republican, said, information from abused prisoners “directly led” to the redoubt, why didn’t the Bush administration follow that trail years ago?
There are many arguments against torture. It is immoral and illegal and counterproductive. The Bush administration’s abuses — and ends justify the means arguments — did huge damage to this country’s standing and gave its enemies succor and comfort. If that isn’t enough, there is also the pragmatic argument that most experienced interrogators think that the same information, or better, can be obtained through legal and humane means.
No matter what Mr. Yoo and friends may claim, the real lesson of the Bin Laden operation is that it demonstrated what can be done with focused intelligence work and persistence.
The battered intelligence community should now be basking in the glory of a successful operation. It should not be dragged back into the muck and murk by political figures whose sole agenda seems to be to rationalize actions that cost this country dearly — in our inability to hold credible trials for very bad men and in the continued damage to our reputation.
By: Editorial Board, The New York Times, May 4, 2011
Paul Ryan’s Moral Barbarism
Karl Rove’s column the other day joined the many conservatives expressing their hurt and anger that President Obama would depict Paul Ryan’s budget as harming sick and vulnerable citizens:
Mr. Obama likes campaigning more than governing. And for this president, campaigning means knocking down straw men and delivering a steady stream of misleading attacks. It means depicting opponents as indecent, heartless people who take special delight in targeting seniors and autistic children.
In fact, Obama has never accused Ryan, or anybody, of having a “special delight” in targetting seniors and autistic children. But he has accused them of pursuing policies that would harm, among others, seniors and autistic children. That’s because it’s incontrovertably true. The Center on Budget and Policy Priorities delves into the details of Ryan’s plan to slash Medicaid by more than a third over the next decade, and in half over the next two decades:
- Seniors: An overwhelming majority of Medicare beneficiaries who live in nursing homes rely on Medicaid for their nursing home coverage. Because the Ryan plan would require such deep cuts in federal Medicaid funding, it would inevitably result in less coverage for nursing home residents and shift more of the cost of nursing home care to elderly beneficiaries and their families. A sharp reduction in the quality of nursing home care would be virtually inevitable, due to the large reduction that would occur in the resources made available to pay for such care.
- People with disabilities: These individuals constitute 15 percent of Medicaid beneficiaries but account for 42 percent of all Medicaid expenditures, mostly because of their extensive health and long-term care needs. Capping federal Medicaid funding would place significant financial pressure on states to scale back eligibility and coverage for this high-cost population, many of whom would be unable to obtain coverage elsewhere because of their medical conditions.
- Children: Currently, state Medicaid programs must provide children with health care services and treatments they need for their healthy development through the Early Periodic Screening, Diagnostic and Treatment (EPSDT) aspect of Medicaid, which provides regular preventive care for children and all follow-up diagnostic and treatment services that children are found to need. A block grant would likely permit states to drop EPSDT coverage, meaning that children, particularly those with special health care needs, would not be able to access some care that medical professionals find they need (because Medicaid would no longer cover certain health services and treatments for children, and their parents wouldn’t be able to afford to pay for that care on their own).
- Working parents and pregnant women: Many state Medicaid programs already have extremely restrictive eligibility criteria for parents. In the typical state, working parents are ineligible for Medicaid if their income exceeds 64 percent of the poverty line (or $14,304 a year for a family of four), and unemployed parents are ineligible if their income exceeds 37 percent of the poverty line ($8,270 a year for a family of four). Under a block grant, states could cut these already low eligibility levels even further, cap enrollment, and/or require low-income parents to pay more for health services. States could do the same for low-income pregnant women who rely on Medicaid for their prenatal care, resulting in them forgoing services that are critical to ensuring a healthy pregnancy.
Now, Rove appears to be a pathological liar, or at least so deeply enmeshed in partisan spin it’s not clear that a distinction exists in his mind between objective truth and claims that are useful to his side. But many other conservatives have likewise expressed what has the ring of genuine outrage that Obama would accuse Ryan of snatching medical care away from people in nursing homes, very poor families, special needs children, and so on. I think it reflects, in part, an inability or lack of desire to think with any specificty about the concrete ramifications of imposing extremely deep cuts to Medicaid. Who do they think is on Medicaid? Prosperous, healthy people?
No, Medicaid is a bare-bones program throwing a lifeline to people who are in bad shape. Cutting Medicaid may be the politically easiest way for Ryan to clear budget room to preserve Bush-era revenue levels, as Medicaid patients have little political clout. But it is, well, deeply immoral. I’m actually surprised that conservatives not only can’t seem to imagine (or care about) the consequences of such policies, but they can’t even imagine that people like Obama would actually feel moral outrage at their plan. They can’t imagine a liberal objection as representing anything other than an attempt to score political points. It’s bizarre. I mean, of course Obama finds it morally objectionable to take away medical care to people in nursing homes and children with special needs. That’s why he’s a Democrat.
By: Jonathan Chait, The New Republic, May 3, 2011
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