Presentation on UK, Spain and Ireland for September 28th 2014

06/10/2014 § Leave a comment

On September 25th RHM Editor, Marge Berer, participated in an evening meeting held to mark September 28th, International Day of Action for the Decriminalisation of Abortion. Delegates at the meeting held at Amnesty International heard from the Central American Women’s Network (CAWN) and Amnesty about the work both organisations are doing in El Salvador to draw attention to the impact of the total criminalisation of abortion on women’s health and human rights. Amnesty launched this report and CAWN screened Life at Any Price.

Marge Berer then did a presentation capturing latest developments in abortion law and policy in Ireland, Spain and the UK.

A note from Marge Berer to potential applicants for the job of RHM Editor

23/07/2014 § Leave a comment

RHM seeks to appoint a new editor in 2015 and the application process is now open. Founding Editor, Marge Berer, has written this note to potential applicants:

Being the editor of Reproductive Health Matters has been an incredible experience. I’ve not only been able to be a full-time editor in this job, but also a lecturer, sharing the knowledge that RHM has published, and a teacher of writing for publication. I’ve also always done this job as an active participant in the field and as an advocate for sexual and reproductive health and rights. In the 22 years since we started the journal, I’ve had the privilege of working with hundreds of the most amazing authors and peer reviewers anyone could hope to meet.

With readers in 186 countries and the support of RHM’s donors, boards and authors, RHM has become a much valued resource in the field for information, knowledge, perspectives, ideas for change on the ground, and recommendations for policy, services, research and action.
The world of journal publishing is increasingly complex and RHM faces a period of transition to online publishing and changes in relation to open access publishing that raise new and different equity-related issues from the past.

Funding will always present a challenge.

However, RHM’s unique perspective, determination to cover controversial, new and neglected issues and challenge orthodoxies is needed now more than ever. I look forward to welcoming someone with the passion and skill to meet these challenges who will take RHM into the future with new ideas and energy.

Details of the job and how apply

A note from Marge Berer to potential applicants for the job of RHM Editor

23/07/2014 § Leave a comment

Being the editor of Reproductive Health Matters has been an incredible experience. I’ve not only been able to be a full-time editor in this job, but also a lecturer, sharing the knowledge that RHM has published, and a teacher of writing for publication. I’ve also always done this job as an active participant in the field and as an advocate for sexual and reproductive health and rights. In the 22 years since we started the journal, I’ve had the privilege of working with hundreds of the most amazing authors and peer reviewers anyone could hope to meet.

With readers in 186 countries and the support of RHM’s donors, boards and authors, RHM has become a much valued resource in the field for information, knowledge, perspectives, ideas for change on the ground, and recommendations for policy, services, research and action.

The world of journal publishing is increasingly complex and RHM faces a period of transition to online publishing and changes in relation to open access publishing that raise new and different equity-related issues from the past.

Funding will always present a challenge.

However, RHM’s unique perspective, determination to cover controversial, new and neglected issues and challenge orthodoxies is needed now more than ever. I look forward to welcoming someone with the passion and skill to meet these challenges who will take RHM into the future with
new ideas and energy.

Details of the job and how to apply

The future as envisioned by WHO for the post-2015 agenda: a serious regression from its long-standing commitments on sexual and reproductive health and rights

08/07/2014 § Leave a comment

Marge Berer

Editor, Reproductive Health Matters

What has gone wrong at WHO? The Lancet’s Offline report (31 May)  of what they call “WHO’s definitive statement about the future it envisions for the post-2015 era of sustainable development” signals a serious regression by WHO away from championing its own policies of many years, and makes for a distressing read. Among the policies WHO should be promoting for the post-2015 agenda setting must surely be:

i) the right to the highest attainable standard of health, as one of the fundamental rights of every human being, a goal which has underpinned WHO’s work since it was founded in 1948,

ii) universal access to sexual and reproductive health and rights, and

iii) strengthening of health systems, taking into account the social and economic determinants of health.

“Universal access to sexual and reproductive health and rights” is in line with WHO’s 2004
Reproductive Health Strategy, approved by the 57th World Health Assembly  and reflects more than four decades of work by the Special Programme of Research, Development and Research Training in Human Reproduction (HRP), based at WHO, and most recently a resolution at the 67th World Health Assembly.

The most important international bodies and leaders currently support the inclusion of universal access to sexual and reproductive health as a crucial goal in its own right under the overarching health goal in the post-2015 agenda, and add reproductive rights to this also under gender equality. The Stockholm Statement of Commitment agreed by 260 Parliamentarians from 134 countries at the Sixth IPCI/ICPD Conference in April 2014 states that access to sexual and reproductive health and rights is an ‘indispensable component’ of the post-2015 development framework. On July 4th a letter from Parliamentarians around the world addressed to Dr Margaret Chan, Director General of the WHO, expressed their concern about the omission of reproductive health and ‘strongly’ support for the Stockholm statement.

Moreover, in consultation after consultation, numerous national and international civil society organisations have called for the inclusion of reproductive and sexual health and rights as an integrated whole as well.

It is a serious mistake on WHO’s part to try to bury this issue under Universal Health Coverage, where it will get lost in a sea of competing finance-oriented interests. To do so discounts the consistent support for these goals by the World Health Assembly as well as the work of countless WHO staff and expert advisors.

There are other indications of a systematic pushback and regression away from work on sexual and reproductive health and rights at WHO as well. It is not reflected as a priority in the 12th WHO Global Programme of Work, nor in the just published Health for the World’s Adolescents, an unprecedented omission. This cannot be taken lightly.

Friends of WHO must do everything they can to ensure WHO assumes its leadership role on these issues again and does not fall back on its longstanding commitments.

Reflections on the recent arrest in London of two people for female genital mutilation (FGM)

14/04/2014 § Leave a comment

Marge Berer, RHM Editor

Last month an obstetrician-gynaecologist and the husband of a patient at the Whittington Hospital in London were charged with the crime of female genital mutilation (FGM) because of a procedure carried out on a woman, following childbirth, who had previously experienced FGM.

This is the first prosecution for FGM in the UK since it was criminalised in 1985 and the law further amended in 2003. This fact may suggest that the Crown Prosecution Service (CPS) have been too circumspect before now in bringing a prosecution. On the other hand, do they think the current case is watertight, given that the woman will have needed some kind of repair following delivery of her baby? Part of the problem is that the lack of previous prosecutions and recent highly emotional and effective campaigning by a new generation of anti-FGM activists may have put pressure on them to bring the only case they felt had a chance of success, even one which may not stand up to legal or clinical scrutiny further down the line.

The decision to make the arrests was celebrated by veteran anti-FGM campaigner Efua Dorkenoo, who was reported on the website of the International Federation of Gynecologists and Obstetricians to have “welcomed news of the first prosecution relating to the procedure in the UK”. At the same time, an article by Sarah Ditum in the New Statesman on 24 March, asked why the first prosecution took 30 years since the law was first passed. Neither woman addressed the details of the actual case, which were unknown, nor whether it was the right place to start.

However, a letter from a group of distinguished, senior obstetrician-gynaecologists, published in the Guardian soon after the arrests, said that for pregnant women whose external genitals had been cut and stitched together, leaving only a small hole for urination and menstruation, defibulation (that is, opening the stitching), is required for them to give birth, and then after the birth, some form of repair is also required. The Crown Prosecution Service are well aware of this, and that the law exempts such repair from prosecution. Indeed, its website with legal guidance on FGM states:

“No offence is committed by a registered medical practitioner who performs a surgical operation necessary for a girl’s physical or mental health… but only if the operation is on a girl who is in any stage of labour, or has just given birth, and is for purposes connected with the labour or birth.”

While it is also “an offence under the Act for any medical professional (or anyone, for that matter) to reinfibulate or close a woman after she has been defibulated during labour for childbirth” this is diffferent from needing to repair the tissue itself. According to this, obstetricians and midwives should have nothing to fear from providing necessary treatment to a woman who has been deinfibulated before or during labour and needs some kind of suturing afterwards. The signatories to the Guardian letter believe that this prosecution, which may be about this very kind of repair, will create a climate of fear for obstetricians and tie their hands when it comes to providing necessary (and sometimes life-saving) care to women who have had FGM in the past.

This case may hinge on whether the procedure carried out was in fact necessary clinical care or actually went further, in particular, by reinfibulating the woman (i.e. sewing her labia together again, effectively reinstating the FGM, which is against the law). This uncertainty suggests that the guidelines (or their interpretation by the CPS) may not sufficiently distinguish between suturing intended to result in reinfibulation, and suturing to prevent bleeding and accelerate healing for a woman whose infibulated vulva has been cut open to make childbirth possible.

The last thing we need in the UK is to obstruct the very medical professionals who have the skills to help pregnant women with the more severe forms of FGM to have their babies safely without resorting to a caesarean section.

For answers, we must await further details of the case. In the meantime, the conflicting reactions of people who are in fact united in their concern for women’s health and their opposition to FGM itself, serve to demonstrate what a blunt instrument the law may be when dealing with a practice such as FGM.

Action against FGM has been taking place in almost every country where it is practised for up to 20-30 years now. According to a comprehensive review by UNICEF, published in 2013, signs of change – reduced prevalence, more local opposition, especially among younger people, less damaging forms of FGM being used, including symbolic pricks and nicks in the clitoris − are finally appearing in a growing number of countries. But change has been slow because girls and women who do not have FGM have simply not been marriageable. Prosecution has rarely been tried in spite of laws against FGM in many places, both in Africa and Europe, because it is believed by many that far from stopping the practice, this would only push it underground. A recent RHM article from Tanzania (1) corroborates this, reporting on the claim by several ethnic groups that FGM has had to be continued in spite of the law to prevent a new form of genital infection, not for its own sake.

Prosecution or doing nothing are not the only two options. Calling for mandatory information in sex education classes is a bit difficult when sex education itself is not mandatory, thanks to government fears of conservative criticism. How to educate ourselves more needs to be debated and discussed, and needs to reflect the knowledge and expertise of those within the communities where FGM is practised. For example, the call from activists from those communities to designate FGM as “child abuse” instead of a cultural practice was extremely powerful.

Those activists believe that prosecution is a necessary part of the package of actions to stop FGM. However, it is important that prosecutions do not push the practice further underground or inadvertently have a negative impact on those health professionals whose practice supports women with FGM to come through childbirth safely, or to restore genital health and sexual pleasure in spite of the previous mutilation (2).

Post Script (16th April 2014)

This case was heard at Westminster Magistrate’s Court on 15th April 2014 and was referred to Southwark Crown Court to be heard on the 2nd May.

(1) Ali C, Strømb A. ‘It is important to know that before, there was no lawalawa.’ Working to stop female genital mutilation in Tanzania. Reproductive Health Matters 2012; 20 (40):69-75 Doi: 10.1016/S0968-8080(12)40664-4).1.

(2) Foldès P, Cuzin B, Andro A. Reconstructive surgery after female genital mutilation: a prospective cohort study. Lancet. 2012 Jul 14;380(9837):134-41. doi: 10.1016/S0140-6736(12)60400-0. Epub 2012 Jun 12.

A selection of RHM articles on FGM, labial surgery and cosmetic surgery:

The limited effectiveness of legislation against female genital mutilation and the role of community beliefs in Upper East Region, Ghana

Female genital mutilation/cutting and issues of sexuality in Egypt

Views of women and men in Bobo-Dioulasso, Burkina Faso, on three forms of female genital modification

Labia reduction for non-therapeutic reasons vs. female genital mutilation: contradictions in law and practice in Britain

Genitals and ethnicity: the politics of genital modifications

Cosmetic surgery, body image and sexuality

These topics have been covered extensively in RHM. All RHM papers older than one year are now free to download from RHM-Elsevier.

Abortion law and policy in Europe: consequences for women

19/03/2014 § Leave a comment

Marge Berer, RHM Editor, presentation at:                                                                         Abortion Law and Policy conference, Dublin 2008 (statistics updated 2014)

 

If you click on the forward arrow after the final slide it will take you to Slideshare pages which are not part of the powerpoint presentation. Please ignore these.

Abortion internationally: law, policy, services, and how the abortion pill changed everything

17/02/2014 § Leave a comment

Marge Berer, RHM Editor, presentation at:                                                                           Comparing our Choices: international and regional perspectives on access to abortion                     University of Ulster, February 2014

If you click on the forward arrow after the final slide it will take you to Slideshare pages which are not part of the powerpoint presentation. Please ignore these.
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