Self-Induced Abortion in Times of Crisis, Part Two

Self-Induced Abortion in Times of Crisis, Part Two

Content warning: sexual violence Despite rampant criminalization of abortion around the world, the international community tends to agree on one thing: an exception in cases of rape or incest. Even in the United States, where abortion is a hotly debated political issue, a majority of Americans support legalized abortion in cases where the pregnancy was caused by rape or incest. Most people agree that women should not have to be doubly traumatized by being forced to carry a pregnancy conceived through violence. Yet in Myanmar and Bangladesh, Rohingya refugees have little choice but to do just that. Since August 2017, a military campaign of ethnic cleansing in Myanmar’s Rakhine State has forced hundreds of thousands of Rohingya Muslims to flee their homes, causing the fastest growing refugee crisis in the world. As one of many ethnic minorities in Myanmar, the Rohingya numbered nearly one million in early 2017. But the government of Myanmar, a predominantly Buddhist country, refuses to recognize...
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Reproductive Health Victories

Reproductive Health Victories

This week has seen an onslaught of negative health news from the United States and around the world. Crisis pregnancy centers in the United States are now allowed to withhold legally available medical options, women in Guam no longer have access to abortion services, and we continue to see daily impacts from the reinstatement of the global gag rule and hear reports of lack of access to reproductive health services from women in refugee camps. It’s easy to get depressed from the seemingly impenetrable amount of work that needs to be done to protect the health and human rights of people around the world. But that’s exactly what we need to do. We need to dig deep, understand the depth of the problems, and develop new partnerships and solutions. I’d like to highlight some exciting news from this past week of just that: people digging deep and developing new solutions to positively impact the health and rights of people across the world. Preventing...
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Self-Induced Abortion in Times of Crisis, Part One

Self-Induced Abortion in Times of Crisis, Part One

Dried henna powder. Animal feces. Bleach. Grain alcohol. The wire coat-hanger. These are some of the many methods women throughout history have used to terminate an unwanted pregnancy. When the safe method for ending a pregnancy--a surgical or medical abortion--is not available, women turn to these alternative techniques, often risking their bodies and lives in the process. Such methods for terminating a pregnancy or inducing a miscarriage are hardly relics of the past. Improvements in contraceptive access, sexual education, women’s empowerment, and abortion access, though significant, have been disparate. In many places around the world, cultural, legal, and financial barriers continue to prevent women from accessing basic healthcare services like contraception and abortion. These obstacles are often magnified in times of crisis. Natural disasters, wars, economic crises, and a host of other factors can all further infringe upon women’s reproductive freedom. Women may lose access to healthcare services, or become uniquely vulnerable to violence. When faced with an unplanned, unwanted,...
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RTI team provides key advice to Duke Big Data for Reproductive Health Team

RTI team provides key advice to Duke Big Data for Reproductive Health Team

On Monday afternoon, the Big Data for Reproductive Health Data+ Team met with Alex Pavluck and Alison Mitchell LeFew from RTI to describe their project and get direction in how to develop a “minimally viable product.” The meeting represents one of the first educational engagements of the Duke-RTI Collaboration. The goal for the 10-week Data+ project is to build a web-based application that will allow users to visualize and analyze contraceptive calendar data from the DHS. Students presented their research on currently available tools, identifying core elements they liked and key areas a new tool could improve. Pavluck, a senior manager for information and communication development for the Global Health Division of the International Development Group at RTI, shared his experience and provided advice on how to develop an MVP for user testing. The active discussion ranged from big picture needs to the technical details necessary to move the project forward. The meeting was a great example of key stakeholder...
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LGBTQ Rights are Reproductive Rights

LGBTQ Rights are Reproductive Rights

If April showers bring May flowers, what do May flowers bring? June rainbows! Each June in the United States, individuals across the nation join in celebrating LGBTQ Pride Month, a time marked by celebration, protest, activism, and, of course, the bright rainbow Pride flag. The tradition was born out of the 1970 Gay Pride March, which took place in New York City to commemorate the Stonewall uprising. As the LGBTQ movement grew, so did Pride marches and within a few years, this form of political protest had spread across the United States, eventually expanding from a single march to a month of events for all LGBTQ people. Over the years, Pride has shifted from primarily a political protest, to a more celebratory occasion. The increasing sociocultural acceptance of LGBTQ people and same-sex relationships has played a role in this shift, and the recent Supreme Court decision in favor of marriage equality is undoubtedly worth celebrating. Yet queer communities certainly remain marginalized...
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Director’s Blog: May 2018

I’m excited to introduce a new monthly feature in which we reflect on current Center activities, upcoming events, and important reproductive health topics in the news. For my first blog, I want to reflect a little on why we wanted to create a Center for Global Reproductive Health at Duke, and what we are planning to do. We created this Center to help catalyze new relationships, research ideas and advocacy that will address the reproductive and sexual health disparities we see around the world. These stark disparities in health outcomes and human rights disproportionately impact women, and have remained present in the face of phenomenal expansions in technology, financing and health systems. They are driven by poverty, gender disparities, restrictive policies, and failure to recognize or implement effective, evidence-based solutions. We’ve all heard about the World Bank report that says more people have access to cell phones than toilets—well, certainly cell phone access is substantially greater than access to cervical cancer...
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Advocacy for Reproductive Justice

Advocacy for Reproductive Justice

Earlier this week, Willie Parker challenged members of the Duke Ob/Gyn Department to remember their role as patient advocates in an inspiring grand rounds lecture, “Advocacy for Reproductive Justice: How Much Fight is there in the Dog?” Dr. Parker, author of Life’s Work: A Moral Argument for Choice, a memoir of how his evangelical upbringing influenced his decision to become an abortion provider, talked about racial and ethnic disparities in unwanted pregnancies, and how the Reproductive Justice movement evolved to address these and broader inequities in sexual and reproductive health. He described how limitations in Medicaid coverage for pregnancy and childcare services disproportionately impact the same groups of women at highest risk for unplanned pregnancy. When access to abortion services is limited, as has been steadily happening for the past 15 years, it is these women who are most vulnerable to not be able to exercise their own choice in determining when and how they want to raise their family. Dr....
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Bringing Multi-Purpose Prevention Technology Development into the Global Spotlight

Bringing Multi-Purpose Prevention Technology Development into the Global Spotlight

Multi-purpose prevention technologies (MPTs) are the future for female-driven sexually transmitted infection (STI) and unplanned pregnancy prevention. Although dozens of products are in the MPT development pipeline, including several at the final stages of clinical trials, progress in development has been slow, and investment paltry. In my last post, I discussed the technical and scientific barriers that are slowing down MPT research. Today I will highlight the comparable societal barriers, namely: lack of government willpower, widespread poor understanding of the depth and breadth of these health issues, and funding troubles. First, though HIV and unplanned pregnancies receive substantial attention in the fields of global health and development, other STIs tend to be much more overlooked. Fewer global health organizations conduct regular surveillance of non-HIV STIs, preventing more funding from going to their prevention. For instance, the World Health Organization’s (WHO) 2015 Report on global sexually transmitted infection surveillance reported an estimated 357.4 million new infections worldwide (roughly 1 million per...
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What We’ve Been Up To and What’s Next

What We’ve Been Up To and What’s Next

It’s been a busy spring semester here at the Center for Global Reproductive Health. We opened the semester with the inaugural Global Reproductive Health Leadership Symposium which brought together ten east African researchers and over 25 Duke fellows, researchers and students for a three-day hands-on meeting at Duke. Attendees shared areas of research, participated in grant writing workshops, and received in-depth training on leadership and mentorship. One of the key events from the Symposium was a lunch session “How Gender, Race, and Ethnicity Can Impact Leadership Opportunities”. With a standing room only crowd, Lola Fayanju from general surgery, Nimmi Ramanujam from Pratt, and Provost Sally Kornbluth engaged in a lively discussion moderated by Kathy Sikkema on their career paths, decision points, and how they have defined themselves as leaders. They also shared key insights on what it felt like to be trailblazers in their respective fields. It was an incredible panel that brought together multiple different sectors and provided real-life context...
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Why don’t we have more MPTs already?

Why don’t we have more MPTs already?

The term “multi-purpose prevention technologies” (MPTs) refers to any single technology that simultaneously protects users against sexually transmitted infections (STIs) and unintended pregnancy. As I discussed earlier this month, MPTs have recently garnered substantial attention and devotion from researchers, as well as a major increase in financial backing from donors. MPTs hold a tremendous potential to transform the lives of women everywhere, especially those in low- and middle-income countries (LMICs), where access to family planning and condoms for STI prevention can be a major challenge. Yet, despite innovative research and vast potential, the only MPTs currently on the market are still internal and external condoms. So, why haven’t more MPTs become available? At first glance, MPTs seem like a pretty simple concept—if a woman is already using a ring that emits drugs to prevent pregnancy, why not add in some prophylactic drugs that prevent HIV transmission as well? Yet, MPT research and development face a multitude of complex hurdles that need...
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