Venezuela Economic Collapse Creates Family Planning Crisis President’S Note

Volume 50, Issue 4 December 2018 Venezuela Economic Collapse Creates Family Planning Crisis President’s Note

“Half the truth is often a great lie.” – Benjamin Franklin

y failing even to mention population growth in the What will they tell hundreds of millions fated to become state- thirty-three-page “Summary for Policymakers” of less environmental refugees, pushed to relocate due to climate its new publication, Global Warming of 1.5°C, the change? What will they say to subsistence farmers forced to BIntergovernmental Panel on Climate Change (IPCC) offered watch their families starve as meager plots become arid waste- less than the whole truth. This is despite the fact that a 2010 lands? And what about the countless, voiceless species doomed paper published in the Proceedings of the National Academy to extinction because so many authorities tremble at the very of Sciences concluded that by the end of the century, slower possibility of a negative reaction? population growth could reduce total fossil fuel emissions by 37–41 percent. Benjamin Franklin, the redoubtable author of Poor Richard’s Almanack, warns, “You may delay, but time will not.” The IPCC “Summary for Policymakers” finds room to call for ecosystem-based adaptation, ecosystem restoration, biodiversity There is no excuse for timid temporizing in the face of a global management, sustainable aquaculture, efficient irrigation, social crisis. When climate experts fail to address population growth safety nets, disaster risk management, green infrastructure, sus- — arguably the single biggest driver of climate change — they tainable land use, and water management. But not one single place far more than their own reputations at risk. word about population stabilization. What is so hard about letting the world know that if every Ignoring the impacts of soaring population growth on climate woman and every couple had unfettered access to all reproduc- change is like failing to mention the Himalayas while describ- tive health services, we’d see population challenges evaporate? ing Nepal. Then maybe, just maybe, we’d have a fighting chance to save Earth as we know it. End this silence, now! Overpopulation remains the elephant in the room. Why the silence? The hard truth is that many experts worry they might John Seager offend someone, somewhere. This is a shameful betrayal of [email protected] reason.

our years ago, I had lunch in the San Francisco home of a hero. Dr. Thomas Hall was awarded Fthat honor by Research!America in recognition of his lifelong leadership on reproductive health and other population-related issues. He shared some of those experiences with me along with tales of sailing adventures. A longtime member of Population Connection, Dr. Hall died last year at the age of 85. He graciously directed a posthumous donation of $250,000 to support our work. His legacy will enable us to reach many thousands of young people so they, too, might in some way help chart the course to a less-crowded future.

Population Connection — December 2018 Volume 50, Issue 4 December 2018

Features Board Chair Estelle Raboni, MPH, MCHES 10 Lacking Birth Control Options, Desperate Venezuelan Board of Directors Aaron S. Allen, PhD Women Turn to Sterilization and Illegal Abortion Andreea Creanga, MD, PhD By Lou Marillier and Daisy Squires Amy Dickson Katie Ferman Bryce Hach, MS 16 As Venezuela’s Health System Crumbles, Pregnant Mark Hathaway, MD, MPH Women Flee to Colombia Padgett Kelly, PhD Nejla Liias, MPP By Anastasia Moloney Sacheen Nathan, MD, MPH Bob Pettapiece, EdD Dara Purvis, JD (Vice Chair) 22 Slowing the “Reproductive Treadmill” in Rural The Hon. Tom Sawyer (Treasurer) Venezuela: The Turimiquire Foundation Story Carol Vlassoff, PhD Kevin Whaley, PhD By Steven Bloomstein Hania Zlotnik, PhD (Secretary) President and CEO John Seager [email protected] Departments Editor Marian Starkey, MSc 2 Editor’s Note [email protected] 3 Letters to the Editor Population Connection (ISSN 2331-0529) Population Connection is the national grassroots 4 Pop Facts population organization that educates young people and advocates progressive action to 6 In the News stabilize world population at a level that can be sustained by Earth’s resources. 8 The ZPG Society Annual membership ($25) includes a one-year subscription to Population Connection magazine. All contributions, bequests, and gifts are fully tax- 26 Washington View deductible in accordance with current laws. 28 Field & Outreach Population Connection 2120 L Street, NW, Suite 500 Washington, DC 20037 30 PopEd (202) 332-2200 • (800) 767-1956 [email protected] 32 Cartoon PopulationConnection.org PopulationEducation.org 33 Editorial Excerpts Cover Image: Oleydy Canizalez, 29, poses for a picture with her husband, Julio Espinoza, 28, and her son Luis, 3, before her sterilization surgery, at their home in Charallave, Venezuela, on July 7, 2016. REUTERS/Carlos Garcia Rawlins

www.popconnect.org December 2018 — Population Connection 1 Editor’s Note

had tentative plans to travel to Venezuela in 2011 to visit the speak of. The consequences in reproductive health have been Turimiquire Foundation, co-founded and presided over by tragic. Unintended pregnancy, unsafe (illegal) abortion, infanti- one of Population Connection’s dedicated members, Steven cide, and maternal and infant morbidity and mortality are all on IBloomstein. Turimiquire offers family planning, education, the rise here, one disturbing story after another. Years of prog- sustainable development opportunities, and humanitarian aid to ress are being rescinded.” the marginalized rural populations of northeastern Venezuela. The situation in Venezuela is desperate, but Steven and his col- As Venezuela plunged into an economic crisis and the socio- leagues aren’t wavering in their determination to make life better political situation in the country grew increasingly unstable, for their neighbors. We are inspired by him and his foundation’s visiting began to feel imprudent and ill-advised, and my trip work, and are committed to being as steadfast in our advocacy was put on hold. in the United States, in the face of political opposition, as he has been in providing health care to the most vulnerable people in With the situation only getting worse, it seems a visit will not the region where he has lived his entire adult life. be in my near future, so I asked Steven Bloomstein himself to write a feature article about the foundation’s work and the peo- This issue ofPopulation Connection magazine includes two ple it serves. Steven has lived in Venezuela since 1973, in the additional feature articles from Venezuela: one about women small coastal town of Cumaná, located about 200 miles east of resorting to permanent sterilization and illegal abortion in the the capital, Caracas. It’s the regional base from which his orga- absence of reversible contraceptive options, and another about nization does outreach to three rural municipalities in Sucre, pregnant women crossing the border into Colombia to seek the state where Cumaná is located. antenatal health care, which they can’t get in Venezuela. We don’t often do an entire issue of the magazine on one single In our messages back and forth about this issue of the maga- country, but I believe that you’ll see the value of a focused look zine, Steven wrote, “What was originally conceived as a family once you’ve read these three articles. planning and education NGO has become a de facto frontline responder to an authentic regional crisis. The demand for assis- tance is enormous and growing, and the people we serve have Marian Starkey literally nowhere else to go. There is no longer a middle class to [email protected]

marks our fiftieth anniversary! Fifty years of advocating for 2018 reasonable, voluntary solutions to achieve zero population growth. We owe it all to the 250,000 cumulative donors who have enabled us to educate millions of young Americans and to be strong, effective advocates for population stabilization. Thank you!

2 Population Connection — December 2018 Send correspondence to

Letters to the Editor [email protected] . Attn: Marian Starkey Letters are also accepted via Population Connection postal mail. Letters may be 2120 L St, NW, Suite 500 edited for clarity and length. Washington, D.C. 20037

I have now received a second issue of Population Connection and brown population growth both domestically and abroad. And am ready to weigh in with my thoughts. The in-depth coverage that it is not population growth, but rather the rapaciousness is excellent, and the articles are informative and timely. I very of capitalism and the consumption of the top 1 percent that is much appreciate receiving this publication. Thank you for the problem. At least that’s the attitude sometimes expressed on including me as a recipient! online forums that I’ve seen. Patricia Ryan To counter that, it would be helpful to have more examples of In the extensive discussion of childlessness by choice in the government ministers and leaders in high population growth September issue, I noted that there was no mention of what I countries who “get” that rapid population growth is a problem consider to be the most important reason to choose to remain for their countries’ futures. childless: What thinking person, who is aware of the many James Larson calamities we face as a result of population growth, can, in good conscience, choose to add to the problem? To me, remaining Leilani Münter promotes environmental activism yet partici- childless, or at least not exceeding replacement fertility, is the pates in professional auto racing, an industry with the carbon most responsible and unselfish choice. This would certainly be footprint of a brachiosaurus. Her advocacy of veganism and the most immediate answer I would give to anyone who inferred her choice to be childfree — even with a dream of race cars that childlessness by choice was “selfish”! someday powered by hydrogen fuel cells or electricity — will

not compensate for her profession’s current wasteful and CO2- Those of us who have been in the population movement for spewing consumption of fossil fuels. many years have no doubt heard the proposition that our poten- tial child might turn out to be a great contributor to mankind. In an era when conservation of resources and wise stewardship The odds of this would be infinitesimal and the additional envi- of the planet are more important than ever, driving round and ronmental burden would be a certainty. round a track at the highest possible speed is no longer a form Don Gentry of entertainment we should be glorifying. The sport of car racing should long ago have been relegated to the scrap heap. The President’s Note in the September issue says that it sometimes seems taboo to bring up population as one of the world’s John Frank problems. And Leilani Münter says that the population stabilization message is not well received by a substantial minority I think you missed the single most important point that influ- and can raise people’s suspicions. ences fertility decline: childcare costs. If economists are alarmed about not having enough future workers, they could support I was surprised that there was no mention of a big reason for taxes and benefits sufficient for providing high quality childcare. why this is the case: that population stabilization is viewed by some as a racist aspiration by white elites to suppress black and Pat Conover www.popconnect.org December 2018 — Population Connection 3 4 Population Connection — December 2018 Design by Mali Welch www.popconnect.org December 2018 — Population Connection 5 In the News

China Reportedly Preparing to End Limits on legalize abortion up to 14 weeks of preg- they will not be able to feed their Childbearing nancy. In August, however, the Senate children. They do not want to work rejected the measure, 38 to 31, with two hard to feed a large family and that China went from having a one-child abstentions. is why they opt for birth controls policy to a two-child policy in 2016, and [sic] and end up with one or two now appears poised to scrap all limits on The country’s health minister, Adolfo children only.1 childbearing in the country. Rubinstein, said during his testimony in favor of decriminalizing abortion Later in the month, the government An early sign indicating that the end of that 354,000 abortions occur each year told organizations receiving USAID the policy is imminent came when the in Argentina — most of them unsafe. funding for family planning to stop design was unveiled for a stamp that will Supporters of the bill claim that 45,000 running ads in the media. Amnesty be released in 2019 for the Year of the – 60,000 women are hospitalized each International’s Deputy Director for East Pig — it depicts two adult pigs and three year as a result. Africa, the Horn, and the Great Lakes, piglets. FDA Approves 12-Month Seif Magango, released a statement in Contraceptive Ring response: Even more telling, a draft of the civil code submitted for consideration at the In August, the Food and Drug There’s no doubt that sexual and 2020 annual meeting of the National Administration approved a 12-month reproductive rights are coming People’s Congress omitted all references vaginal contraceptive ring, name brand under increasing attack in Tanzania. to family planning. Annovera. The ring is inserted for three The government’s deplorable deci- weeks, removed for one week, and rein- sion to pull these family planning Although couples have been permitted serted, following this pattern for up ads comes less than two weeks after to have a second child for three years to one year. The ring is 96–98-percent the President made derogatory now, the communist government has effective, according to the FDA. remarks about Tanzanians wish- had little success in raising the birth rate. ing to exercise their fundamental Annovera was developed by Population right to make decisions about their In a country where forced steriliza- Council, a non-profit organization based bodies. tion and abortion were commonplace in New York, New York. until recently, elective abortion and even Tanzania’s President The Tanzanian authorities must divorce are becoming more difficult to Shames Women for Using immediately stop obstructing access obtain. Birth Control to sexual and reproductive health Argentina Narrowly services and end the intimidation of Rejects Abortion Bill Tanzanian President John Magufuli anyone providing information about reportedly said the following at a rally in such services — be they health Abortion in Argentina is currently only September: workers, journalists, or activists. legal in cases of rape or threat to a woman’s health, dating back to a 1921 law. In Women can now give up contracep- June, Argentina’s Chamber of Deputies, tive methods. Those going for family 1 Side note: Magafuli has only two the lower house of Congress, voted to planning are lazy ... they are afraid children.

6 Population Connection — December 2018 Global Hunger Rises for Third Year cost is a barrier, you get into a situation when population growth is accompanied where one of two things could happen: with increases in affluence and carbon- The 2018 State of Food Security and you see private clinics develop — we intensive consumption.” Nutrition in the World delivered some don’t want that to happen in Ireland, sobering news. According to the report, we want this to be part of an integrated In December 2015, 195 UN member chronic food deprivation increased from public health service — and secondly, states adopted the Paris Agreement to 804 million in 2016 to nearly 821 mil- you can see people having to continue to “[hold] the increase in the global aver- lion — approximately one out of every travel.” age temperature to well below 2°C nine people in the world — in 2017. New Climate Report above pre-industrial levels and [pursue] Reiterates Importance efforts to limit the temperature increase The highest prevalence of undernourish- of Halting Global to 1.5°C above pre-industrial levels.” ment was in sub-Saharan Africa, at 23.2 Temperature Increase The Agreement entered into force in percent of the population. The highest November 2016. At this time, however, number of undernourished people was The Intergovernmental Panel on Climate only 181 Parties of the 1972 signatories in Asia, at 515 million. Change (IPCC) issued its latest report have ratified the agreement. The United in October. The report was prepared by States, under Donald Trump, became the The number of stunted (low height/ 91 scientist authors and review editors only country to officially withdraw from length for age) children under the age of from 40 countries, and contains over the agreement in June 2017, saying it five declined by 9 percent, to 150.8 mil- 6,000 scientific references. was bad for the U.S. economy. lion. Still, more than one in five children globally was stunted. And 7.5 percent of The report explores the consequences of The full title of the report is Global children — 50.5 million — under the global atmospheric warming by 1.5°C Warming of 1.5°C, an IPCC special report age of five suffered from wasting (low above pre-industrial (1850 – 1900) lev- on the impacts of global warming of 1.5°C weight for height/length). els (it has already warmed by 1°C). It above pre-industrial levels and related Ireland to Offer Free also addresses the factors causing global global greenhouse gas emission pathways, Abortion Now That warming (including population growth), in the context of strengthening the global Procedure Is Legal and outlines mitigation options. response to the threat of climate change, sustainable development, and efforts to After only becoming legal in Ireland in According to the report, “If the current eradicate poverty, and it is available for September, abortion will now be accessi- warming rate continues, the world would download at ipcc.ch/report/sr15/. ble to all, free of charge. The procedure’s reach human–induced global warming legalization was due to voters over- of 1.5°C around 2040.” whelmingly supporting a referendum 2 Nicaragua signed on in October 2017 in May, with Irish expatriates returning The one mention, in the 695-page and Syria signed on in November 2017, home to vote in the thousands. report, of population-related measures bringing the total Parties to 197. as a mitigation strategy was disappoint- Health Minister Simon Harris told a ingly passive: “Reductions in population reporter, “I’ve said from the start that I growth can reduce overall carbon demand don’t want cost to be a barrier, because if and mitigate climate change, particularly www.popconnect.org December 2018 — Population Connection 7 RECOGNIZING MEMBERS OF THE ZPG SOCIETY What Will Your Legacy Be?

If you aren’t yet a member of the ZPG Society, have you considered becoming one? The simplest way for you to ensure that your dedication to Population Connection’s mission continues well into the future is through a gift — a bequest — in your will. You can create a bequest by adding just one Population Connection’s ZPG Society honors those sentence to your will. And that sentence can make the difference of a lifetime! who have established a Charitable Gift Annuity with us or who have included Population Connection in Contact Shauna Scherer at [email protected] or (202) 974-7730 for more their estate plans. We are grateful to our ZPG Society information. members for their generosity and far-sightedness. Sample Bequest Language: Thank you! After fulﬁ lling all other provisions, I give, devise, and bequeath ___% of the remainder of my estate [or $___ if a speciﬁ c amount] to Population Connection (Tax ID #94-1703155), a charitable corporation currently located at 2120 L Street NW, Suite 500, Washington, D.C. 20037.

Deanne L. Adams Susan Curry & Gail M. Daniels Gary Harrold Walter Lindell Bob Pettapiece Steve Stodola & Joyce Thompson Sharon Allen Janet Curtis & Charles Curtis Anna Heath John Lochhead & Danielle Lochhead Frank A. Pezzanite & Judy C.M. Pezzanite Linda Stokely Mahmood Anwar Guy E. Dahms Nancy Heck Douglas Longman Linda M. Plein Guy W. Stoye Phil Arndt Allan L. Daniel & Kendra Daniel Dan Heisman & Shelly Hahn Dwight E. Lowell II & Kimberly F. Lowell James Podanowski Lawrence E. Stueck & Kathleen McQuiston Robert L. Arner Jimmie Darr & Gayle Darr Max Heppner & Irene Heppner Doni Mae Felicity Pool Lorraine Sumner Melissa Aronson Ginny Darvill Dianne Herman Norman Mandelbaum Denise Powers Elizabeth A. Swain David Asch Richard S. Dennison & Diane Dennison William W. Hildreth Craig Mandsager Gladys Powers Charlotte B. Swartz Ginger Bachem & Fritz Bachem Robert E. Detjen Regina Holt Christopher Mathews & Catherine Penelope Purtzer Rowland W. Tabor Bill Baird Debbie Dill Agnes Hughes Mathews Donald W. Rea Jeffrey Terrill Christopher Barry Raymond H. Dominick John Hutcherson, MD T. D. Mathewson Frederick J. Retzlaff Jennifer Thiermann Robert A. Barry Julian Donahue & Katharine Donahue Michael Ihlenfeldt David R. Matteson & Sandra Matteson Joseph F. Rice Roland Tozer Catherine Z. Becker & Richard J. Becker Fay Dresner Dirk Iwema & Karen Iwema Elaine McAuliffe Curtis C. Ridling Gloria D. Valdespino Sally Beers Richard Dresser & Sylvia Dresser Laura L. Jackson Gary W. McCormick Carrie Robertson Jan van Heurck Robert Behm & Gayle Behm Richard M. Dubiel Rosalie Jacobs Landon B. McDonald Phil Rockey Shelley Varga Keith Berg & Mary Hedblom Lee Dunn & Tharon Dunn Heidi M. Johnson Bernadette McNulty Larry Rodgers & Alice Rodgers Irene Wakeland & Robert Wakeland Lynn Bertucci Nancy Farrell-Rose Pierce Johnson, Jr. David Miller Monica Roy William Warburton Rose S. Bethe Kirsten Fearn Sheri L. Jones G. Robert Miller Nancy G. Ryder Robert Wehle Mark R. Bickett & Jeanette L. Entwisle Robert Ford Cheryl Jurrus Peter Mitchell Amy S. Sanders David R. Weindorf & Doris Weindorf Kenneth J. Bierman Bill Foster Paul H. Kaser Russell Moffett Virginia K. Schilz Richard W. Weiskopf & Linda DeStefano Tom Bimmermann Robin R. Friedheim Ann Peckham Keenan Roberta Moody Hermann F. Schmid Jay R. West Barbara Bird Doug A. Gardels Barbara Keeton Marvin M. Moore Judith Scott Jo Lynne Whiting John C. Brandt & Dorothy A. Brandt Don C. Gentry Carol Ann Kell Bill Moritz Jamie Shaw & Christopher Cope Steve F. Willey & Elizabeth Willey Darrell Q. Brown Susan Gerber Vicky Kemp & Grant Kemp Phillip S. Morse Harry Sherrington & Charity Sherrington John N. Wilson Mark C. Brucker Paul L. Gerhardt & Barbara Gerhardt Justine Kirk Eva Moseley Ron Shissler & Lucille M. Shissler Dorothy Winkey Leo R. Buckert Ivan C. Getting Hunt Kooiker & Linda Whinnery Mary Moses Leon G. Siegel Alice Wolfson John S. Burt Armand F. Girard Mary Koziar Andrew Mossa & Linda Mossa Bob Sizoo & Sue Turner William H. Wolverton Leonard N. Butters Ken Goehring Michael E. Kraft & Sandra K. Simpson-Kraft Barbara Q. Myers Ken Smith & Kathy Smith Kenneth Wright & Virginia Wright Diane Carlin Robert M. Goodwin & Margaret L. Richard F. Krawiec Marcia Newfield Victor G. Soukup Wayne Wright David B. Chamberlin Goodwin James E. Kunz James P. O’Callaghan Margaret E. Sowerwine, MD Douglas N. Young Harriett Clark Eric Gordon James Larson Dorothy Olson Bella Starmountain-Sweet Sarah Clark Richard Green Cheryl Lechtanski Lt. Col. James E. Page, Ret. Bob Starr * Honorary Member Audrey Clement Ben Grego Dorothy Leong & Andy Leong S Page Steven R. Stegner Matthew Cooper & Dawn Cooper Julia A. Gregory Rebecca Yee Hun Leong Lau* Mariette I. Parent & Arthur L. Parent Richard Stein Kalya Cotkin James Griffith Jeff Lesak & Merrily Swoboda Ronald G. Parker Judy C. Stevens Gene Cripe & Marilyn C. Cripe David Hanna Ellis Levinson & Cheryl Levinson William Peppler Tara Stevens

8 Population Connection — December 2018 RECOGNIZING MEMBERS OF THE ZPG SOCIETY What Will Your Legacy Be?

www.popconnect.org December 2018 — Population Connection 9 Lacking Birth Control Options, Desperate Venezuelan Women Turn to Sterilization and Illegal Abortion Article and photos by Lou Marillier and Daisy Squires | Originally published on The Intercept (6/10/18). Republished with permission.

arling was up at 4:30 a.m. on a warm and windy April in central Caracas. At 8 a.m., doctors would cut a four-inch morning, breastfeeding her one-year-old baby in incision in her stomach and remove a piece of her fallopian the one-bedroom house she shared with her three tubes, sterilizing her for life at twenty-one years old. A thirty- Dchildren and her sick mother, in the El Junquito slum in western minute surgery, which would last forever. But at least Darling Caracas, Venezuela. From the top of her hill, she could see the knew she wouldn’t end up like her sister Jennifer, just twenty- city sparkling in the distance, its streets deserted since sunset. three and with five children and no food to feed them. People rarely dared to venture out into the darkness anymore, in a city that has become notorious for being the most violent An increasing number of young Venezuelan women are going capital in the world. to extreme lengths not to give birth to another child. They are in an impossible bind, in a country where abortion is forbidden Darling dropped her three sleepy children at her father’s house by law and a box of contraceptive pills costs the equivalent of right below hers, climbed the hundreds of steps and steep dirt up to ten months’ salary at the minimum wage. Their determi- path leading to the main road, jumped in a bus, rode the sub- nation illustrates the depth of Venezuela’s economic crisis, the way, and finally, at 7:10 a.m., entered the waiting room of a worst in the country’s history, and its disproportionate impact private clinic in the upscale neighborhood of Sabana Grande, on women.

This page: Patients in Caracas wait outside PLAFAM, the country’s main family planning organization, at 5:30 a.m. Opposite: Natalie, thirty-one, had six children, but her baby died at nine months old because she didn’t have money to treat his asthma.

10 Population Connection — December 2018

Above: Krisbell, twenty-seven, wanted three children, including a son, but opted for sterilization after her two daughters were born because of the tenuous situation in Venezuela. Left: Cytotec pills, intended to treat ulcers, are also widely used [illegally] to induce abortion.

— has become either unavailable or unaffordable.

“Women’s power to decide whether they become mothers or not is violated,” On May 20, 2018, Venezuelan President has skyrocketed an estimated 13,779 said Magdymar León, psychologist and Nicolás Maduro won a second term in percent over the last twelve months, coordinator at AVESA, a local NGO an election that was boycotted by most according to the opposition-led National focusing on sexual health. “It’s some sort opposition parties and denounced by Assembly (the government stopped of forced maternity.” a coalition of other Latin American giving an official figure last year). For countries. The minimum wage is cur- most Venezuelans, that means contra- There are shortages of between 80 to 95 rently 1 million bolivars per month, or ception — and nearly everything else percent of all medications nationwide, the equivalent of $0.56, and inflation according to local NGO Médicos por la

12 Population Connection — December 2018 Salud, and contraceptives are especially There are no publicly available statis- Doctors in private clinics also noticed an affected. “Contraceptive methods are tics on these campaigns or on the rates increase in demand. Rhayza Martinez, not considered essential medicines. So, of sterilizations, but all factors indicate a gynecologist who worked in four dif- in the crisis, the ministries and providers a rise in demand. Dr. Wilson Torrealba, ferent private clinics all over Caracas, favor other kinds of medicines, like anti- surgeon and chief of the obstetrics and said that five of the fifteen patients she hypertensives or cancer treatment,” León gynecology service at Altagracia de received every day asked for sterilization. explained. “We consider that contracep- Orituco hospital in Guárico state, was tive methods should be included as well, supervising the campaign in his hospi- “I am scared and I think about a lot of because sexuality is now being pushed to tal when it started in April 2017. “We things, like the fact that later on, I would the margins of public policies, which has knew it was a political move, but even so, like to have another son,” said Krisbell, a direct impact on women’s lives.” we participated because we were going a twenty-seven-year-old mother of two to help many patients who had a large girls who was planning on getting steril- So far, Maduro has consistently refused amount of children,” he said. “We were ized. (The Intercept is using only the first to open a humanitarian aid channel or solving a social problem.” names of the women who spoke to us recognize the depth of the crisis, con- about their ordeals for this story, for their demning instead an “economic war” Before the crisis started, sterilizations privacy and safety.) “But those are deci- waged by the United States though in Torreabla’s hospital were only made sions that you have to think through, and sanctions. Indeed, President Donald available for women over thirty-five with given the current situation, it’s better to Trump has issued sanctions that ban three or more children, or for younger give comfort and security to the kids you U.S. entities from buying bonds from women suffering from an illness that already have than to think about having the Venezuelan state or its oil company, made pregnancy a risk. The steriliza- another one that you could be bringing PDVSA. There are concerns that since tion campaigns were supposed to follow into the world to suffer.” oil accounts for 95 percent of Venezuela’s those guidelines, but Torrealba said that export revenue, which is in turn used to at his hospital, it quickly spiraled out of risbell’s fears are well grounded: import goods like food and medicine, his control. A recent government report oil-related sanctions only increase the showed that infant mortality suffering of the population. “Some patients got sterilized at eigh- Krose by 30 percent in 2016. teen or nineteen years old with only one The government’s positions on repro- child, which shouldn’t have happened,” Natalie, thirty-one, had just been ductive health are contradictory. On he said. For these reasons, Torrealba said through what the other women were one hand, it offers stipends to pregnant he gave up coordinating the campaign doing all they could to avoid. She lived women and for every new child born, after four months, during which he esti- with her five children in a house on the even as Venezuela holds the highest rate mated around 400 to 500 women were edge of the “Punta Brava,” or “crazy of teenage pregnancy in Latin America. sterilized. hill,” a part of the Antímano slum that Inflation has rendered these already owed its nickname to regular shootings. small stipends minuscule — 700,000 Catherin, a medical student who interned Before the crisis, Natalie could feed her bolivars ($0.39) per pregnancy and 1 mil- in a public maternity clinic and the gyne- five children, but by the time her sixth lion bolivars ($0.56) per newborn — but cology department of a public hospital child was born in the summer of 2017, León argues that they have contributed for six months in 2017, said that she had the situation had deteriorated. “CLAP to a culture that encourages mother- to screen girls as young as 14 who were boxes” filled with subsidized food that hood at any age. “It’s a cultural thing, asking for a spot in the free sterilization Maduro introduced in 2016 had started more accentuated in lower-income areas: days. It had become their only solution: arriving much more sporadically than Maternity is not a choice, but part of “We wouldn’t have 18-year-olds asking they used to, and without essentials like your fate,” she said. to get sterilized if they weren’t desper- milk or beans. Sometimes, Natalie ended ate,” Catherin said. (She asked that her up selling some of the sugar in the box to On the other hand, the government also real name not be used out of concerns it buy cigarettes to sell, and then buy a little funds periodic national campaigns for could jeopardize her career.) more food from that money — often just free sterilization days in public hospitals. chicken skin and bones, bananas, and www.popconnect.org December 2018 — Population Connection 13 the same problems I’m going through with the baby, not having diapers, not “We wouldn’t have eighteen- having milk or money to buy it,” said her sister Jennifer. She had gotten ster- year-olds asking to get sterilized ilized as well, right after she gave birth to her fifth child. The newborn was mal- if they weren’t desperate.” nourished, as the lack of nutritious food during Jennifer’s pregnancy meant that –Catherin, a medical student who has screened girls as her breasts didn’t produce milk, and she young as fourteen who were asking to be sterilized could rarely find baby formula.

or women who don’t have the kind of support Darling had and yucca. But it wasn’t enough, and her chil- even more so because of her occupa- can’t afford sterilization, a last, dren often went to bed hungry. tion, Krisbell spent a big part of her days Fand far more dangerous, option exists: standing in lines to buy food or medi- home-induced abortion. In the fall of 2017, her baby got asthma. cine. There, she met Darling and other He started swelling and had a hard time young women who bonded over their Venezuela, where 70 percent of the pop- breathing, becoming so weak that he fear of getting pregnant and sharing tips ulation identifies as Catholic, has among couldn’t even cry. She tried to find medi- on where to get sterilized. the strictest abortion laws in Latin cine, but the treatment was too expensive America. Abortion is forbidden even in and too intermittent. Not long after he On the day of Darling’s sterilization, the case of incest or if the fetus displays was hospitalized, Natalie’s baby had two Krisbell came along, relaxing the atmo- life-threatening malformations, and is heart attacks and died at nine months sphere with her wit and energy. Her own punished by six months to two years in old. “My son died because I didn’t have sterilization was meant to take place a prison. (Because of those penalties, The the money for his medicines,” Natalie week later, but as Darling’s anesthesia Intercept has changed the names of the said. Beyond the grief, Natalie was scared started wearing off in the clinic’s win- women who shared their stories of illegal for two of her other children, who had dowless room and she vomited on the abortions.) also developed respiratory infections. floor, Krisbell wasn’t so sure anymore. “I’m gonna shit myself,” she said matter- Despite this, Anna, a twenty-seven- Because of equipment shortages, many of-factly to Darling’s stepmother, Maria. year-old single mother of two who was a public hospitals and maternities have In the corner of the room, the sectioned month-and-a-half pregnant, had decided also stopped offering sterilization days pieces of Darling’s fallopian tubes had to go through with it. “Imagine if I have for now, local sources said. Women who been thrown in a plastic bottle split in another baby now in these conditions. can afford it go through PLAFAM, the half, releasing a pestilential smell. Later, There aren’t even diapers or anything. I country’s main family planning organi- Maria would carry the bottle back home don’t work. What can I do?” she said. “If zation, or pricier private clinics. Krisbell to Darling’s father. the situation was different, I would have and her husband saved up for three my baby.” months in order to afford the 13 mil- Darling’s sterilization at a private lion bolivars (then $19) that the surgery clinic cost 78 million bolivars, she said, Anna went to her neighbor, Janine, who would cost at PLAFAM, the equivalent the equivalent of $118 at the time of had been through an abortion herself of more than a year at minimum salary. the operation, and a fortune for most and had been dedicated to helping other They work as “bachaqueros,” an often Venezuelans. She had received the young women. Janine had instructed her derogatory term that designates people money from family in Peru, and although on what to buy: four Cytotec pills — who buy food and medical supplies at her and her sister’s children barely had originally meant to treat stomach ulcers the government-controlled price to then enough to eat, her family considered the but widely used for abortions — for a sell it at an inflated price on the black operation to be a priority investment. total of 8 million bolivars ($12 at the market. Like most Venezuelans and “It’s much better for her. She won’t have

14 Population Connection — December 2018 time) on the black market, as well as rue hemoglobin levels so low that they need a 65.8-percent increase in instances of herb and a malt soda. blood transfusions.” maternal mortality from 2015 to 2016.

“If the government’s help is not enough, If anything went wrong, Anna said she Those numbers are a stark reminder then who is going to help these girls? would rather endure the pain at home that women have borne the brunt of It’s not ideal and I don’t agree with it, than go to a hospital; she had heard sto- Venezuela’s crisis. As she was waiting because it’s murder, since a baby in the ries of doctors mistreating women who for Darling to wake up from her surgery, womb is a life already. But when you had attempted abortion or refusing them her stepmother Maria remarked, “We think about it, the baby would suf- care. (Torrealba denied this, saying that women suffer for everything. Having fer,” said Janine, as she put the rue herb all emergency cases are treated as though children, and stopping having them.” and the soda to boil. Once the mix was they were spontaneous abortions, mean- That sparked laughter from Krisbell. ready, Janine instructed Anna to drink ing the fetus died for some other reason.) “Men couldn’t take this,” Krisbell said. four cups of it, along with two pills of “They really couldn’t.” Cytotec, and to insert the two remaining Magdymar León, the AVESA coordina- pills in her vagina. tor, said that many women shared Anna’s fear. “It’s not an isolated perception. The procedure wasn’t only illegal, it Effectively, this happens and obviously was also risky. “Most of them induce since women think it will, they’d rather their abortions using pills like Cytotec not go,” she explained. The consequences Originally published on The Intercept or introducing foreign objects in the of not going to the hospital could be (6/10/18). Republished with permission. A video that accompanies the article is vagina,” said Torrealba, the hospital doc- grave. “These insecure abortions add located here: theintercept.com/2018/06/10/ tor. “We quite frequently get patients to maternal death rates,” added León. venezuela-crisis-sterilization-women- with severe hemorrhages that get their Ministry of Health bulletins indicate abortion/

Darling, twenty-one, has three children, and opted for an expensive sterilization in order not to end up like her twenty-three- year-old sister, who has five children and struggles to feed them.

www.popconnect.org December 2018 — Population Connection 15 As Venezuela’s Health System Crumbles, Pregnant Women Flee to Colombia

By Anastasia Moloney | Originally published by Thomson Reuters Foundation

xhausted but relieved, Yariani Flores lay next to her healthy newborn son, along with four other Venezuelan women who just gave birth in a +hospital in Colombia’s border city of Cucuta. E Thousands of Venezuelan women have done the same over the past few years, as the health system in their home country has crumbled. They crossed the border, driven by fear that they or their babies could die.

Early in her pregnancy, Flores sought a prenatal checkup at a municipal hospital in Venezuela’s frontier state of Tachira only to be told that there was little+ point. “The doctor said, ‘Don’t bother coming here, I can’t do much for you,’ ” said Flores, lying in the twelve-bed maternity ward at Cucuta’s Erasmo Meoz University Hospital. “She recommended I come to Cucuta and have the birth here.”

Venezuela’s economic crisis has laid waste to its health system. The numbers of babies and women dying during or after childbirth have soared, while medicines and supplies have become increasingly scarce.

“You have to bring everything to the hospital in Venezuela,” said Flores, a thirty-three-year-old mother of five. “There aren’t even any surgical gloves.”

A March survey of 137 hospitals, led by the opposition- A pregnant woman arrives at a medical dominated Congress, showed that they often lack basic camp set up by medics from Argentina’s equipment like catheters, as well as incubators and x-ray White Helmets in Cucuta, Colombia, units. June 27, 2018. REUTERS/Carlos Eduardo Ramirez

16 Population Connection — December 2018 www.popconnect.org December 2018 — Population Connection 17 Venezuelan hospitals are also plagued by Below: A woman carrying a child connects with Venezuela, has borne the walks past a Colombian policeman after water and electricity outages, and only 7 having crossed from Venezuela over the brunt of the influx. percent of emergency services are fully Simon Bolivar international bridge in operative, the survey found. Cucuta, Colombia, February 13, 2018. At the main hospital alone, Erasmo REUTERS/Carlos Eduardo Ramirez Meoz, about 14,000 Venezuelan patients Opposite: A woman carrying a baby Infant mortality in the oil-rich nation queues to try to cross into Colombia have been treated in the past three years, rose 30 percent last year, according to from Venezuela through Simon Bolivar most with no health insurance, said Juan the latest government data. Maternal international bridge in San Antonio Agustin Ramirez, director of the five- del Tachira, Venezuela, August 3, 2018. mortality — dying during pregnancy or REUTERS/Carlos Eduardo Ramirez hundred-bed facility. within forty-two days of giving birth — shot up by 65 percent. Nearly 820,000 Venezuelans have left The hospital has debts of about $6 mil- their homeland to live in Colombia dur- lion accumulated to care for Venezuelans, Health Care Overwhelmed ing the last fifteen months, with arrivals which the Colombian government has Venezuela’s economic meltdown, includ- expected to continue, according to yet to reimburse as it promised last year, ing hyperinflation, is now putting a Colombian authorities. Ramirez said. financial strain on the health system in Cucuta and other Colombian cities. Cucuta, the largest city along the porous “This has created a financial crisis ... and frontier and separated by a bridge that there comes a time when we collapse,” he said.

18 Population Connection — December 2018 Until recently, the hospital treated only Ramirez said Colombia has a duty to Ramirez said. “We have an immense a few Venezuelans, mostly for road inju- help Venezuelans. debt with Venezuela.” ries, Ramirez said. Colombians often refer to Venezuelans In the past year, about 54,500 Venezuelan But now, on any given day, up to as their “brothers,” as they share close migrants have received emergency care one in five patients at the hospital is cultural and family ties. in public hospitals across Colombia, Venezuelan, and its crowded emergency according to authorities, while nearly ward is overwhelmed. In past decades, it was Venezuela 200,000 have been vaccinated, many at that opened its doors to millions of border crossings. Many are children suffering skin dis- Colombians fleeing civil war. Many eases, diarrhea, and respiratory problems. found jobs and cutting-edge medical But only patients needing emergency Others are women who have high-risk care in the once prosperous nation, care, including pregnant women, get free pregnancies and arrive malnourished, Ramirez said. treatment. having had few or no prenatal checkups. “We can’t forget that during all these Those with chronic illnesses, like can- “It’s a sign that something serious is hap- years of violence in Colombia, 4–5 cer, kidney failure, and HIV/AIDS, pening with public health in Venezuela,” million Colombians went to Venezuela are turned away because of a lack of Ramirez told the Thomson Reuters where they were given services for free,” resources. Foundation.

www.popconnect.org December 2018 — Population Connection 19 “For those poor people, the situation is Malnutrition Across town at a shelter run by the catastrophic,” Ramirez said. Another casualty of Venezuela’s crisis Scalabrini International Migration was laid bare at the hospital’s children’s Network, a Catholic organization for Earlier this month, the Organization of ward. migrant aid, pregnant women are given American States reiterated its call on priority while other Venezuelans sleep Venezuela to allow international aid into A severely underweight four-month-old on cardboard outside, waiting for a bed the country, to ease what it has described baby from Venezuela’s Yukpa tribe slept, and a hot meal. a “humanitarian crisis.” hooked up to an intravenous tube to help him recover from malnutrition. Keila Diaz, twenty-three, who is heav- Many expect the migration to continue ily pregnant with her second child, came following the re-election of Venezuela’s About two-hundred Yukpas have fled to the shelter with her husband in May. socialist President Nicolas Maduro in hunger in their ancestral lands. They now When the contractions start, she said, May, which the United States called “a live in ragged, makeshift tents just inside she will head to the hospital. sham” and many countries refused to Colombia, near the border crossing. recognize. “I’m afraid to have my baby in Venezuela. Below: Colombian police officers stand Babies die, mothers die giving birth over in front of people queueing to try to cross “We are not prepared, nor are we going into Colombia from Venezuela through there,” said Diaz, gently rubbing her to be prepared, if there’s a bigger exodus Simon Bolivar international bridge in bulging belly. “I have a better chance of citizens from Venezuela as conditions Cucuta, Colombia, January 24, 2018. here.” REUTERS/Carlos Garcia Rawlins deteriorate even more,” Ramirez said.

20 Population Connection — December 2018 HOW IT WORKS DONATE 1.

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TO LEARN MORE CALL OUR PARTNERS AT CARS AT 855-500-7433, OR GO ONLINE TO careasy.org/nonprofit/population-connection www.popconnect.org December 2018 — Population Connection 21 Slowing the “Reproductive Treadmill” in Rural Venezuela: The Turimiquire Foundation Story By Steven Bloomstein, President of the Turimiquire Foundation

n the 1970s, I was part of a small the age of thirty-one, in a small mud hut intervention. Primitive slash-and-burn group of North Americans, all located a two-hour walk from the nearest agriculture and small-scale subsistence recent college graduates, who road. She died while being carried down surface mining have led to deforestation, relocated to the northeastern state of rocky foot trails and across mountain riv- erosion, and contamination of topsoil Sucre in Venezuela to pursue tropical ers in a blood-drenched hammock, in a and surface water, as well as decimation Ifruit farming. The remote valley desperate attempt to get her to the road of the country’s remarkable biodiversity. where we have lived and worked since and then to the local hospital in time to then is typical of the impoverished save her life. Her newborn died shortly Turimiquire is based in the city of hinterlands along the South American thereafter. Brunilde’s death became a Cumaná, the capital of both our Caribbean coast. Far removed from major impetus to create the Turimiquire municipality and the state of Sucre. public sanitation, medical care, and Foundation, a non-profit organization We focus primarily on family planning social services, our campesino (country) registered in the United States in 1996 and secondarily on rural education and neighbors — while living in what many to seek tax-deductible funding in order development, responding to the stated of us might consider a tropical paradise to offer family planning and education priorities of the communities we serve. — were and are, by standard economic to rural communities in Venezuela and From the beginning, working closely indicators, extremely poor, generating prevent such tragedies in the future. with the State Ministry of Maternal- barely enough income to feed and clothe Infant Health, supplementing its their large families. When we first In the time that we have lived and worked existing infrastructure, good policies, and arrived in our community, illiteracy was in Venezuela, the number of inhabitants willing staff with our personnel, logistics, the norm. Girls often had their first child has grown from about 12 million in the and contraceptive supplies as needed, at fourteen or even younger, giving birth 1970s to well over 30 million in 2018. we were able to have a palpable impact to a new baby every other year, so that it Very few of the country’s public services in our largely rural county. Over time, was not uncommon for a thirty-year-old have been able to keep up with this pop- responding to word-of-mouth demand, woman to have seven or eight kids, with ulation growth. The public health system we extended our outreach to two addi- another on the way. Many women went has been overwhelmed by the large and tional rural counties. Through June 2018, for years from one pregnancy to the next growing demographic that is — or soon on a shoestring budget, the Turimiquire without experiencing menstrual periods. will be — of reproductive age, and fam- Foundation had served over 45,000 low- Maternal and infant mortality and ily planning services are limited in scope income mainly rural women with more morbidity were prevalent facts of life. and rarely available. Electricity and water than 170,000 cycles of hormonal contra- are frequently rationed, and to accom- ceptives, 8,000 IUDs, and 6,400 surgical In the early years, our crew did what we modate all the youngsters coming of sterilizations, and had conducted more could to help local families get repro- school age, public schools now work on than 3,000 reproductive health work- ductive health care and family planning a double shift schedule, offering primary shops for over 55,000 teens. We have through our friendships with doctors classes in the morning and secondary cumulatively offered over 100,000 and other professionals in the nearby classes in the afternoon. Sadly, although “couple years of protection,” the metric city of Cumaná. The death of acampesina Venezuela has great natural beauty and by which USAID measures family plan- neighbor in childbirth in 1994 became abundant natural resources, ranging ning achievement, to the low-income our wake-up call to do more. Brunilde from coastlines to mountains to jun- populations that we serve. died from postpartum hemorrhaging gles, the once-pristine environment has after giving birth to her seventh child, at been degraded by unregulated human

22 Population Connection — December 2018 Cumaná

Above: Map of Venezuela with Sucre state in red. ©TUBS, Wikimedia Commons | Right, top: Sociologist Amarylis Jimenez leading a rural reproductive health workshop | Right, middle and bottom: Dr. Maria Eugenia distributing family planning materials to rural health care providers

Our experience strongly validates family planning as a powerful catalyst for prosperous families, thriving communities, and healthy ecosystems. We have directly witnessed how, as family size shrinks and maternal and infant morbidity and mortality decrease, each family’s modest resources go further, children grow up healthier, and families can afford to send their (fewer) children to school. Youth, especially girls, thrive with the educational opportunities that their parents never had, and isolated rural communities are invigorated. In the rural areas where population growth has slowed because of our family planning services, we have observed a reduction in slash- and-burn agriculture, leading to less erosion, reforestation, replenished water- sheds, and returning wildlife.

But we have reached only a small per- centage of the population in the vast rural hinterland that surrounds us. In many of these areas, the reproductive treadmill continues unabated as it has for the past centuries, bearing its quota of pain and tragedy. The enormous unmet need for family planning beckons to us from all sides, just beyond our current realm of influence. Scaling up to meet this demand is our ongoing dream. www.popconnect.org December 2018 — Population Connection 23 Above, left: Sociologist Juan Carlos leading a rural reproductive health workshop | Above, right: Dr. Silvia Quijada, Turimiquire Foundation surgery coordinator, holds a Population Connection envelope being used to deliver paperwork to a surgery team. Steven Bloomstein, right, says that Population Connection envelopes also come in handy for distributing condoms, especially to adolescents concerned with privacy.

he teenage pregnancy rate in refusing to eat or otherwise cooperate nobility of mature women forced to bear Venezuela continues to be one with a healthy pregnancy, until finally yet another pregnancy under impossible of the highest in Latin America, she had an extremely difficult, life- circumstances. The wrenching trauma of andT the world. Sixteen-year-old Maria threatening, and frightening birth with parents whose teenage daughter becomes came from the countryside to study poor medical support. One of her babies pregnant and puts herself at risk to ter- and work in the capital city of Cumaná, died immediately, and the other baby minate the pregnancy, or drops out of the local magnet for rural immigrants. died shortly thereafter. After six months school to care for the newborn under A sweet, vivacious girl, she grew up in of painful recovery and feelings of shame, the same impossible circumstances. The a large family in a remote mountainous during which the father of the twins was frustrated love lives of couples who fear area. Maria and one of her brothers are nowhere to be found, Maria resumed her an unintended pregnancy. The intimate the only literate members of their family. previous student and workaday life, sadly partner violence that occurs when par- Her innocence was short-lived after she and decidedly wiser. ents can’t appropriately channel the arrived in the city, however, and when stress of their reproductive situation. The she unintentionally became pregnant, In another of so many similar stories, children who face limited life prospects she was mortified. She used her very thin nineteen-year-old Gabriela was not so as scant resources must be spread thin. physique to hide her pregnancy until fortunate. She died in childbirth at the almost the seventh month, though many local hospital, following a difficult preg- nd if life wasn’t already difficult of the experienced women in her milieu nancy that she resisted and denied as enough for poor Venezuelans, suspected the truth of her situation. long as she could. Gabriela’s child just everything has become much Maria did not seek an (illegal) abortion, barely survived delivery and is being harderA in the current economic crisis. anathema to her rural culture, but she raised by her immediate family. The steep deterioration of the economy did everything she could to discourage and associated social and political strife the pregnancy from progressing. She We also see cases of (sometimes fatal) have led to the collapse of public family stopped eating to flatten her abdomen, illegal abortion complications, newborn planning services and a severe scarcity took folkloric “remedies,” exercised abandonment, and even infanticide, of contraceptives at the national level. inappropriately, and followed whatever but they are less common. What I have Families are more desperate than ever bizarre suggestions her peers and others most painfully witnessed in my years of to control their fertility in a time when gave her. When her family finally working in the field is the tragic human raising a child is formidably difficult. saved money for and insisted on an price paid by families when they do not ultrasound, it showed not one fetus, but have ready access to reproductive health The Turimiquire Foundation has two. Even then, she continued in denial, education and family planning: The sad responded to the decline of public health

24 Population Connection — December 2018 services by strengthening and expanding the past twenty years, the Turimiquire in middle age, it is not unusual for neph- its partnerships with the willing-and- Foundation may well have become the ews and nieces to be older than their able private health care sector. Working most affordable provider of safe surgi- aunts and uncles.) together through social marketing, we cal sterilizations in Venezuela. Women have been able to maintain and even come to us from all over the eastern half t the Turimiquire Foundation, increase our services in the face of the of the country, including from the capital we have seen reproductive growing unmet need for family planning. city of Caracas, some 200 miles to the health in our target populations Our biggest challenges are the extreme west. The average age of our patients is tangiblyA improve in the two decades shortages and hyperinflationary costs of about thirty years old, and the average since our founding. We have developed short-term contraceptives — condoms, number of children they have is four. and demonstrated proven strategies to birth control pills, injectables, and emer- These measures are shifting to a younger deliver our services, and our small local gency contraceptive pills. Our existing average age with a smaller number of initiative has grown to become the only inventory will not last through the end of children, as we have already reached recognized reproductive health non- this year, and there’s little hope of stock many of the older women in our purview profit serving three rural counties in replenishment in sight. and younger women are deciding earlier our state of Sucre. We are proud of the to have fewer children. positive impact that the Foundation has Long Acting Reversible Contraception had in so many rural communities and (LARC) offers an important alternative, Over the years, Turimiquire has seen urban barrios (neighborhoods). and thanks to a grant from the Erik and mothers and daughters come to the clinic Edith Bergstrom Foundation (which together to be sterilized on the same day When we started, our mission was to also supports Population Connection), — a family event. Gleibys, forty years keep women like Brunilde from dying we will be able to sustain our current old with three children, and her daugh- from preventable causes through access delivery of IUDs, add implants as a hor- ter Girardine, twenty years old with two to family planning. Over the years, hav- monal alternative, and continue apace children, came together from their rural ing seen for ourselves the multitude of with surgical sterilizations into the com- community to have their surgical steril- benefits that family planning brings, ing year. izations on the same day. Gleibys did not we have learned that meeting repro- have her eldest daughter until she was ductive health care needs is not only a Since the late 1990s, we have provided twenty years old, but Girardine already cornerstone of family and community remote rural populations with short- had two children by that age. well-being, but the key to prosperity in term contraception via the nurses who poor rural environments. Our vision has maintain the rural dispensaries through- In another example, Francis, forty years expanded, and we are truly grateful to all out the state. But placing IUDs and old with two children, and her daughter our institutional and individual donors implants requires doctors and medical Francis Riva, twenty-five years old with for giving us the opportunity to con- infrastructure — not generally available three children, came into the clinic from tinue this critical effort throughout and in remote rural areas. To address this a small coastal fishing village to have beyond these tumultuous times. challenge, we are partnering with rural their sterilizations together. Francis gave townships that can provide public buses birth to Francis Riva when she was fif- to bring groups of eligible women to the teen (not uncommon in remote rural clinics where we provide our LARC ser- areas), used an IUD for many years, vices and take them home afterwards, and recently had another baby. In order often an all-day enterprise. to avoid any future pregnancies, which at her age would be high-risk, she chose The Turimiquire Foundation was formed Surgical sterilization (tubal ligation) is to be sterilized. Francis Riva already had in 1996 to help the poor rural communities Venezuela’s most popular form of birth three children and considered her fam- in northeastern Venezuela. Turimiquire, pronounced Too-ree-mee-kee-ray, means control. Traditionally, women have had ily complete. Her children are the older “Seat of the Gods” in the indigenous Carib the number of children they desired, often niece and nephews of her mother’s baby language, and refers to the mountain range without physician-recommended spac- boy. (In rural areas where childbearing that dominates this tropical coastal area. To ing, and then sought sterilization. Over typically begins in adolescence and ends learn more, please visit turimiquire.org. www.popconnect.org December 2018 — Population Connection 25 w

ie Reproductive Rights Hang in the V Balance as 2019 Nears By Stacie Murphy, Director of Congressional Relations ashington W

Congress Funds Title X, he got funding for a border wall, Donald Appeals Court to Rule on Punts on International Family Trump signed the measure soon after it Abortion Rights for Minor Planning passed. Immigrants In late September, Congress approved a In late September, a three-judge panel fiscal year 2019 spending package that No Word on Domestic Gag from the United States Court of Appeals extended current funding through early Rule for the District of Columbia Circuit December 2018 for some programs and As reported in our September issue, the heard arguments on whether the U.S. authorized full-year funding for others. Trump administration has indicated that has the right to deny abortion access Title X, the nation’s family planning pro- it intends to alter the rules governing to pregnant minors in the custody of gram for low-income populations, was funding for Title X. Under the proposed immigration authorities. The Justice in the latter category, and was funded change, no entity receiving Title X fund- Department claims it does, arguing that at the 2018 level of $286.5 million. ing could “perform, promote, refer for, or the government “has a strong, legitimate, Abstinence-only programs, meanwhile, support, abortion as a method of family and profound interest in the life of the saw a $10 million increase. planning, nor take any other affirmative child in the womb.” action to assist a patient to secure such The State Department and Foreign an abortion.” The head of the Office of Refugee Operations budget, which includes U.S. Resettlement, Scott Lloyd, is fervently international family planning funding, Additionally, Title X-funded providers anti-choice, and made headlines in 2017 was among those extended until after would not be required to offer all forms when it was revealed that he person- the election. The expectation is that this of FDA-approved contraception, nor ally visited young, pregnant detainees to December, the 115th Congress will pass be required to discuss all options with attempt to persuade them to carry their another extension to see the remaining pregnant patients. The required “notice pregnancies to term. During the hear- programs through until after the 116th and comment” period — a rule-making ing, the government revealed that 420 Congress is seated. As matters stand procedure that ensures members of the young, pregnant immigrants were in fed- now, bilateral family planning programs public have an opportunity to weigh in eral custody last year. Eighteen requested are funded at $575 million and the U.S. on changes — ended on August 31. As abortions. Eleven obtained the proce- contribution to UNFPA is $32.5 million yet, there has been no further informa- dure, five withdrew their requests, and — although the current Kemp-Kasten tion from the administration, though two were released to sponsors, so the out- determination barring funding to the advocates do anticipate the rule being come of those pregnancies is not known. organization means that money has been confirmed. Typically, such a change “reprogrammed” to other women’s health would only go into effect after a one-year The court is hearing the case after a dis- initiatives. “implementation period,” but whether trict court judge issued a preliminary the Trump administration will adhere to injunction against the government in Despite months of vague threats about custom in this instance is yet to be seen. March, ruling that the Trump admin- shutting down the government unless istration policy of attempting to block

26 Population Connection — December 2018 young immigrants’ access to abortion at which Dr. Blasey Ford and Judge of all Republicans except for Alaska’s was probably illegal. No decision had Kavanaugh both testified. Blasey Ford Lisa Murkowski. Maine senator Susan been announced as of our print deadline. spoke first, telling the committee she Collins, who has frequently broken with was “100 percent certain” Kavanaugh her party on reproductive rights and Kavanaugh Replaces Kennedy, was her attacker. The judge issued a flat women’s issues over the years, declined Roe Hangs in the Balance denial of the assault, though the rest of to do so in this instance. Collins said After sailing through his initial confirma- his testimony was full of evasions and that while she believed Blasey Ford tion hearings, Judge Brett Kavanaugh’s downright preposterous assertions (e.g. was telling the truth about having been appointment to the U.S. Supreme Court he and the other boys who called them- assaulted, she must have been mis- was nearly derailed when multiple selves “Renate alumni,” referring to a taken as to the identity of her attacker. women came forward with allegations female acquaintance, obviously intended Additionally, Collins said, she believed of past sexual misconduct. Dr. Christine to signal only respect and friendship, and Kavanaugh was not a threat to Roe v. Blasey Ford, a professor of psychology at if you suspect otherwise you have a dirty Wade. West Virginia’s Joe Manchin was Palo Alto University and a research psy- mind). the only Democrat to vote in favor of chologist at Stanford University, alleged confirmation. that when she was fifteen, Kavanaugh On September 28, on a party-line vote, and a friend assaulted her at a gather- Kavanaugh’s nomination was advanced Looking Ahead ing of high school friends. Another out of committee, although several Washington View is frequently a chal- acquaintance, Deborah Ramirez, Republicans agreed that further investi- lenging column to write. So often, our claimed that at a drunken college party, gation of the allegations was appropriate early print deadline means that things I Kavanaugh exposed himself and shoved before any final vote could be taken. The write about have changed by the time the his genitals at her face. A third woman, White House authorized a one-week, magazine arrives in readers’ mailboxes. Julie Swetnick, described witnessing limited FBI investigation. On October 3, This is never truer than with a column Kavanaugh and his high school friends the FBI announced that it had completed like this one, written before an election deliberately targeting girls, encourag- the supplemental probe, though agents but read after. So much depends on what ing them to drink heavily, and lining up failed to interview either Dr. Blasey Ford happens (happened, now, from your per- outside of rooms where intoxicated girls or Judge Kavanaugh about her allega- spective) on November 6. The outcome were being assaulted by multiple boys. tions. The FBI did interview Deborah will determine much of the trajectory She claims she was later raped by a group Ramirez, although reports also indi- for 2019 and beyond, not only for fam- of boys at just such a party, although she cate that they did not speak to any of ily planning, but also for so many other did not accuse Kavanaugh of being one the corroborating witnesses she named. issues facing our nation and our world. of her attackers. On October 6, despite massive public On September 27, the Senate Judiciary protests, Kavanaugh was confirmed to Committee held an additional hearing, the Supreme Court, with the support www.popconnect.org December 2018 — Population Connection 27 A Tough 2018 Means We’ll Fight Even Harder in 2019 utreach By Lauren Salmiery, Senior Field Coordinator & O ield F

here is no question that 2018 has been a challenging year for reproductive rights and social justice.T With the looming threat of a domestic gag rule on providers of Title X family planning, the unlawful detention of immigrant children, the continued denial that climate change is occurring and is caused by human activity, and the Above: The #Fight4HER Summit in Denver brought together community groups, activists, confirmation of partisan, vengeful Brett and passionate reproductive rights defenders. Kavanaugh to the Supreme Court, there is a lot to fight. Left: Las Vegas Our #Fight4HER campaign is doing #Fight4HER Summit just that! In Arizona, Colorado, Nevada, participants New Hampshire, North Carolina, Ohio, gather from Pennsylvania, and Wisconsin, organiz- across Nevada ers, volunteers, and passionate defenders for a day of of reproductive freedom have been work- workshops and ing tirelessly in their communities to fight trainings back against attacks on reproductive rights, and to build support for the Global HER (Health, Empowerment, and Rights) Act.

In August, #Fight4HER organizers around #Fight4HER Summit partners included the ACLU of Wisconsin, NARAL Pro- the country rallied over 400 community Choice North Carolina, the National Jewish Women’s Council, NextGen Arizona, members and volunteers for #Fight4HER and Planned Parenthood Advocates of Ohio. Summits. Attendees learned about the Global Gag Rule, gained organizing skills Ohio State University students gather on campus to honor International Safe Abortion Day and tips, and heard from other coalition groups in their communities.

#Fight4HER organized around days of action like International Safe Abortion Day, World Contraception Day, and National Voter Registration Day. We mobilized communities around the country to rally in support of access to reproductive healthcare and rights. We raised awareness about the importance of keeping abortion safe, legal, and accessible for all people.

28 Population Connection — December 2018 Below: #Fight4HER Tucson organizer Kristen Godfrey (center) and volunteers Ashley Little (left) and Zoe Watchman (right) attend an International Safe Abortion Day speak-out at the University of Arizona

Above: #Fight4HER Phoenix organizer Brittany MacPherson (right) and volunteer Jamila Rahim (left) collect petitions in Tucson, AZ. We’ve delivered thousands of petitions to members of Congress, asking them to “support the Global HER Act, and vote against any and all efforts to roll back access to safe, affordable, and accessible comprehensive reproductive health care for people around the world.”

Around the country, Population Connection staff and volunteers raised our voices against the confirmation of Brett Kavanaugh to the U.S. Supreme Court. The common theme: We do not consent! Left: Population Connection staff attend the Cancel Kavanaugh march in Washington, DC Right: Marian Starkey protests outside Sen. Susan Collins’ office in Portland, ME

www.popconnect.org December 2018 — Population Connection 29 Empowering Teens: New Activism Toolkit from PopEd By Pamela Wasserman, Senior Vice President for Education d E o p P

If everybody with goodness in their heart got up and did something to change the world, it would be a much better place. We just need to remember that we can do it, no matter how hard it may seem.

— Cameron Kasky, via Twitter (Class of 2019, Marjory Stoneman Douglas High School, Parkland, Florida)

highly functioning democracy Listening to Young People But teens don’t have to lead national demands civic engagement. Even before they are old enough to vote, movements to make a difference. Our When too many citizens treat kids and teens can be effective activ- activism toolkit provides guidance on theirA democracy as a spectator sport, ists on issues that excite and motivate a range of activities small and large. tyranny by the minority — where them. Consider the courageous students Developed by our 2018 Duke University politicians and policies don’t represent who survived the shooting last February Stanback interns Nadia Thompson and the views of the majority of the people at Marjory Stoneman Douglas High Caroline Reents, the toolkit provides — can occur. Sound familiar? School in Parkland, Florida. Within days a wealth of background resources and of experiencing the nightmare of having “how to” ideas for affecting change in So how do you get people to pay atten- an active shooter in their school, and students’ schools, homes, and communi- tion, think critically about important while mourning the loss of many of their ties, as well as in society at large. Reents, issues, and step up to be active and vocal friends, these students were speaking out an Environmental Management gradu- citizens? against gun violence, confronting their ate student, sees the toolkit as a way to lawmakers, taking social media by storm, help students to “harness the passion Not surprisingly, our PopEd team thinks and planning nationwide marches and they fostered through the video contest citizenship education needs to start with rallies. Months later, they were still using and teach them ways to turn that pas- young people. That’s why, this fall, we their newly-honed civics skills to register sion into concrete actions that make a launched our World of 7 Billion Activism young voters and inspire their peers. difference.” Toolkit. This new resource can be viewed at worldof7billion.org/activism-toolkit/. Polls show that today’s teens hold more progres- Many students who take the time to sive views than older learn about critical global issues and cre- generations on issues rang- ate educational videos for our World of 7 ing from environmental Billion student video contest are looking protections to women’s for additional ways to use their talents reproductive rights to and enthusiasm to be change agents. social justice. Though the Now, they’ll have some resources to help voter turnout among young them get started. 2018 Stanback interns Caroline Reents and Nadia adults has been historically Thompson, developers of the PopEd Activism Toolkit low (just 43 percent among

30 Population Connection — December 2018 18–24-year-olds in 2016), there appears six areas of activities for all degrees of 6. “Influencing Lawmakers” to be a new energy among youth to par- engagement: Contacting legislators, attend- ticipate more fully in the democratic ing public events (i.e., town halls), process. 1. “Practice What You Preach” participating in rallies and marches, Ideas for daily changes for a and, of course, voting Knowing the Issues sustainable future, including The first step in effective activism is to recommended apps to help track Filling a Need understand society’s pressing issues in individual carbon output and make Even though many agree that civic order to be able to translate relevant conscientious consumer decisions engagement is vital to a thriving democ- information into persuasive messaging 2. “Making Changes in Your School” racy, civics education has not been a and projects. The toolkit provides back- Starting environmental clubs, advo- priority in school curricula for most of ground readings and resource links on a cating for new class offerings (like the country. In fact, only nine states and variety of population-related issues from environmental science or compre- the District of Columbia require stu- climate change to wildlife to women’s hensive sex education), tabling at dents to take a civics or government class health and education. Eight issue areas school events, or hosting a speaker to graduate high school. And very few of represent topics that have featured for a school-wide assembly the available curricula include experien- prominently in students’ video entries 3. “Making Changes in Your tial education like the activities described over the past few years. Community” in the toolkit. Tabling at community-wide events There’s also a section on being a critical or hosting events like watch parties, With so many issues demanding urgent consumer of information. With so much park clean-ups, or food drives public action — from climate change to information just a click away, it’s impor- 4. “Using the Media” human rights to pollution to feeding a tant for students to know which websites Writing letters to the editor, growing population — there’s no better are reputable and to be able to recog- creating a social media following, time to encourage some of our youngest nize bias when they see it (and how to hosting a podcast, and sharing citizens to take an active role as advo- fact check when they aren’t sure). We’ve World of 7 Billion contest videos on cates for a sustainable planet and human included a link to Factitious, an online YouTube wellbeing. game that tests one’s ability to spot hoax 5. “Fundraising for Your Cause” news items. Tips for online fundraising and Find the Activism Toolkit, along with profiles of two former video contest this year’s student video contest details at Taking Action participants who initiated effective worldof7billion.org. Once students feel knowledgeable about fundraising around issues they care the issues, they will find a variety of about — preventing child marriage ways to get involved. The toolkit outlines and protecting coral reefs www.popconnect.org December 2018 — Population Connection 31 Cartoon

32 Population Connection — December 2018 Editorial Excerpts

It’s long been evident that the demonization of Planned The confirmation of Brett Kavanaugh was a setback to the Parenthood by the leaders of Texas government is depriving legitimacy of the U.S. Supreme Court and the stature of the women of essential care. As the years roll by, new details emerge Republican-controlled U.S. Senate, and a threat to an array of about the inadequacy of the providers struggling to fill the gap Americans’ rights that have been barely preserved by a divided created when state officials effectively blackballed a century-old court in recent years. organization that women had long turned to for reliable, high- quality health services. Kavanaugh’s swearing-in leaves little mystery about the future direction of the court. The disastrous consequences of the state’s reproductive health care policy — a festival of folly that began with the removal of As a candidate, Donald Trump made plain that he would be Planned Parenthood as a provider in 2012 — have been docu- nominating justices who would repeal the landmark 1973 Roe mented in academic studies and in the work of journalists such vs. Wade decision guaranteeing a woman’s reproductive free- as the Texas Observer’s Sophie Novack. Novack’s most recent dom. It is now only a matter of time until that decision is tested article focused on the dismal performance of one provider: the with two Trump appointees, including the one he was gifted, Heidi Group, led by an anti-abortion activist with no experi- Neil Gorsuch, by a Republican Senate that resolutely refused to ence running a family planning program. allow even a hearing for President Barack Obama’s appointee, Merrick Garland. State officials had acknowledged that the Heidi Group was fall- ing short of its targets, but they had refused to provide details. It was the height of hypocrisy for Senate Majority Leader Using the state open records law, Novack got the numbers: for Mitch McConnell to complain about Democrats’ delay tactics fiscal 2017, the Heidi Group had pledged to cover 70,000 cli- because they reasonably insisted on seeing many thousands of ents. In reality, it covered just 3,300 — meeting less than 5 withheld documents about Kavanaugh’s work in the George W. percent of its obligation. How did the state respond? Bush White House, and then demanded a fuller investigation into multiple allegations of sexual assault against Kavanaugh. It renewed the group’s multimillion-dollar contracts for a third year. The treatment of Christine Blasey Ford, the Palo Alto University professor who accused Kavanaugh of sexual misconduct when It’s the most dramatic example of a broader problem of under- they were in high school, will not be easily forgotten. Many performance: Novack reported that while the Heidi Group got of the key Republicans were often dismissive when they were a reprieve, the state did pull funds from 30 other contractors in not being outright misogynistic — as if her poignant, credible the state’s two reproductive health programs this year. testimony could be brushed aside for the partisan imperative of getting him on the court. Trump’s mockery of Ford at a Reversing this misguided decision wouldn’t lead to a single Mississippi rally was repulsive even by the low standards he has additional abortion. What it would do is save taxpayers money set for his presidency. and help prevent lots of unwanted pregnancies while restoring vital health services to thousands of Texas women. – October 6, 2018

– October 4, 2018

www.popconnect.org December 2018 — Population Connection 33 Population Connection 2120 L Street NW, Suite 500 NON PROFIT ORG US POSTAGE PAID Washington, D.C. 20037 POPULATION CONNECTION

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