The Center for International Reproductive Health Training at the University of Michigan (CIRHT) partners with academic institutions in developing countries to integrate competency-based pre-service training in Family Planning and Comprehensive Abortion Care, revamping research culture and improving the quality of care, ultimately strengthening capacity for life-saving reproductive health services.

This news review is one way we hope to keep an ongoing conversation with our partners and the global reproductive health community. (Hyperlinks in the text lead to relevant articles.)
It was a busy two months with conferences and travel, so please excuse this longer-than-usual double-issue newsletter. We hope you find it informative and see it as a holiday treat you can peruse at leisure.
Elections and Policies Matter
The US midterm elections saw a “Blue Wave” of Democrats taking over the US House of Representatives and many state legislatures and governorships. How that will affect reproductive rights remains to be seen but the signs are promising that some of the assault on choice coming from the Trump Administration may be slowed. The matter is never simple, though, as restrictions exist even for doctors who want to provide abortion services outside of their main employment: religious-based health systems are prohibiting them in their employment contracts. Other rules have been introduced that allow employers to deny birth control coverage ( publicly opposed by ACOG). The US abortion rate is the lowest it has been for a decade, helped by birth control access, but the administration policies could undo the progress.   
   
We start with that look at US politics because the implications of the country’s policies on reproductive health, contraception and abortion, are being felt around the world. “ Birth control access is rising in world's poorest countries as Republicans try to limit it in U.S.” Secretary of State Mike Pompeo even tried to eliminate sexual health terminology from UN documents. The Global Gag Rule sows “ confusion, chaos, and fear of retribution of a pretty punitive government.” There is strong evidence to suggest that the Global Gag Rule leads to more rather than fewer abortions, projected to lead to 2.5 million unintended pregnancies and 870,000 unsafe abortions,” and in Malawi “ threatens lives”, where between 6% and 18% of all maternal deaths can be placed on unsafe abortion.

The Tanzanian government is trying to reassure the international community that it has “ no intention to scarp its family planning policy” despite statements from the president, the World Bank pulled a $300 M loan over the country’s school ban for pregnant girls.

A similarly mixed picture from Kenya, where the effects of banning Marie Stopes International (which says it is still operating) “ will hurt the poor”, and has been challenged in a lawsuit by the Center for Reproductive Rights. Though Kenyans are having fewer children, averting “ 2 million pregnancies in the race against overpopulation,” women are still victims of “ reproductive coercion,” forced to resort to “ secret family planning.”

Benin is promoting sexual education from a young age, in part to avoid the increase in clandestine and dangerous abortion. Making contraception available to young people is also being discussed, debated and implemented in Burkina Faso, Republic of Congo, Rwanda, Uganda and Zimbabwe, where students are rejecting “smelly ‘madembare’ condoms.” One way to increase availability: “ manufacture condoms in Africa”, according to UNFPA ESARO. Other contraception news: First Trial Launches to Test Effectiveness of Male Contraceptive Gel.

A study shows that half of reproductive age US women want easier access to abortion pills, especially as access to clinics is being restricted and even dangerous. With the availability of access by mail increasing, one article argues it “highlights the need to decriminalize abortion worldwide.” (One such debate concerning medication abortion is taking place in Senegal).

The ongoing debate about abortion can descend into the absurd: One Australia senator “ declared himself a woman” arguing that doing so would prevent him from being attacked over his stance on abortion. In another instance, a man accused of statutory rape cited the “Life Begins at Conception” anti-choice argument to prove his alleged victim wasn’t a child.  
Conference Registration
UM-CIRHT will be hosting " Family Planning and Comprehensive Abortion Care: Strengthening Preservice Training", a conference in Addis Ababa 4-5 April 2019.

Please see the website below for registration details:

Congratulations to our founder, Dr Senait Fisseha
CIRHT founding executive director Dr. Senait Fisseha was named as one of Africa's 100 Most Influential People by New African Magazine, citing her as the worldwide "face of expanding access to reproductive health."
UM-CIRHT and partners at ICFP
UM-CIRHT and partners from Ethiopia and Rwanda presented a wide range of research at ICFP in Kigali in November, including on "Strategies to Improve Uptake of Postpartum IUD in Kigali" and "Unmet need for contraception among HIV-positive women attending HIV care and treatment service at Saint Paul’s Hospital Millennium Medical College, Addis Ababa, Ethiopia"

Links to the presentations will be found on the UM-CIRHT research page.

Video Highlights of the UM-CIRHT sponsored session on "Enhancing Pre-service Training to Expand Access to Family Planning and Comprehensive Abortion care in Ethiopia." can be found here.

A selection of news coverage of ICFP:
ICFP News
Devex @ ICFP, Devex, 19 Nov 2018
No consensus on how to curb teen pregnancy, The East African, 17 Nov 2018
Faith Community Commits to Strengthen Family Planning Work at ICFP 2018, Christian Connections for International Health, 16 Nov 2018
Uganda wins family planning award, Dispatch, 16 Nov 2018
Rwanda wins int’l family planning gong, Journal du Cameroun/APA, 16 Nov 2018
#ICFP2018 Closes, with Sights Set on 2020, Global Health Now, 15 Nov 2018
Virtual Vasectomies: Not Just for Men, Global Health Now, 14 Nov 2018
Les succès du Sénégal et du Burkina célébrés à Kigali, Agence de Presse Senegalaise, 13 Nov 2018
Annual Progress Report Launches at ICFP, Medium/FP2020, 2 Nov 2018
Moving forward / Moving sideways / Moving backwards - October news
Forward:

The government in DRC, where complications form unsafe abortion are common, is popularizing (in French: “vulgarization”) its adoption of Article 14 the Maputo Protocol which guarantees women’s right to reproductive health, including access to contraception and abortion, which local papers say is leading the way to safe abortion service and women’s opportunity.

In Benin, communities are working together to “ tackle abortion stigma” and engage civil society in a broad discussion about family planning.

A study in IJGO lauded Ethiopia’s implementation of safe abortion services, an effort that succeeded through government leadership, NGO involvement, and expansion of health professional education.

Rwanda has made changes to its abortion law that no longer require court intervention. While restrictions still exist, some activists say the law signals “ an important step forward in the promotion and respect of women’s rights.”


Religious leaders in Nigeria “may be the key” to family planning efforts, which the Nigerian Urban Reproductive Health Initiative study says will contribute to boost the number of clients, as the government works to “ mainstream” family planning policies and “ reduce death by 30%.”

Egypt has approved $19 M for family planning, in a country that “ cannot benefit from development” at the current birth rate.

Botswana has one of the fastest falling fertility rates, in part attributed to being “very proactive in in establishing a family planning programme that was far-reaching in terms of its geographical reach, providing access to most people in the country to a range of contraceptive methods.”

At the release of the annual Mo Ibrahim Foundation Index of African Governance, the philanthropist stated that “ Africa must tackle the birth control taboo” to “beat poverty”. 

Sideways:

Kenya offers a set of contradictory stories. “ One in every three girls aged 15 to 19 in Kenya has an unmet need for family planning according to KDHS 2014. The number is similar among women aged 20 and 29,” in part thanks to bishops’ insistence on abstinence-only. For married women, “ Kenya tops the East African region in the use of contraceptives.” In the background, the Trump Global Gag Rule, which one family planning provider said “ was akin to signing her patients’ death sentence.” (The Washington Post published an excellent view of how the Gag Rule “ reverberated around the globe.”)

South Africa has “ wonderful laws”, but not the “ people to implement those laws,” as “conscientious objection” obstructs access to safe abortion. Ghana recorded 53,000 abortions at public health centers in 2017, yet unsafe abortion is “ soaring.”

The US landscape is in flux: Justice Brett Kavanaugh was confirmed to the Supreme Court, putting both sides of the abortion debate “ gear up for battle.” The Trump Administration “ religious exemption” birth control policies will result in “ contraception deserts,” and could put 25 M women in 20 states at risk of losing abortion rights, even though “ 6 in 10 Americans say abortion should be legal in all or most cases.” Yet federal courts in Kentucky and Virginia issues ruling protecting abortion access. KFF offers a compendium of state policies on abortion access.      

Backwards:
Tanzania’s President John Magufuli “ bluntly attacked contraception,” saying high birth rates are good for the economy and calling users “lazy.” At the same time, the health ministry put a temporary ban on family planning advertising and Marie Stopes International was forced to close 10 clinics.

Pope Francis compared having an abortion to “ hiring a hitman to solve a problem.”

Only half of Namibian women have access to contraceptives. A Kenyan man in Lesotho was arrested for assisting a woman with an abortion.

An assessment of Family Planning Service Availability and Readiness in 10 African Countries in GH:SP concluded “the availability of oral contraceptives, injectables, and condoms varied greatly, and the availability of basic items indicating service readiness, such as guidelines, trained staff, equipment, and certain commodities, was low.”
2018 Nobel Peace Prize
Congratulations to Dr. Denis Mukwege and Nadia Murad for receiving the Nobel Peace Prize.


Dr. Mukwege was honored at the University of Michigan in 2010 with the Wallenberg Medal.

Dr. Mukwege's son, Alain Mukwege, has been at the University of Michigan since 2015, working with researcher Janis Miller (see below) and others at the School of Nursing to support Dr. Mukwege's Panzi Foundation and Hospital in Bukavu, Democratic Republic of Congo.

UM-CIRHT and partners at FIGO
UM-CIRHT partners from Ethiopia and Rwanda presented supported research at the FIGO 2018 conference in Rio in October.

Congratulations to our Ethiopian partner Awol Yemane Legesse of Mekelle University for winning the prestigious Ipas  Best Papers recognition.

Congratulations also to our Rwandan partner Magnifique Irakoze from the University of Rwanda who was elected Vice President of the World Association of Trainees in Obstetrics and Gynaecology (WATOG).

For a rundown of the abstracts presented, please see the UM- CIRHT website's research area.
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African News References - November
A lot of news -- from 24 countries this month. We are always interested to hear your feedback and suggestions about relevant news and new sources.
Benin
Alerte sur les avortements sauvages, L’Evenement Precis, 24 Nov 2018

Botswana
Batswana young women throwing caution to the wind, The Sunday Standard, 23 Nov 2018

Burkina Faso
Santé sexuelle et reproductive des adolescents, Sidwaya/All Africa, 12 Nov 2018

Cote d’Ivoire

DRC

Ethiopia

Ghana
NPC launches population & development media awards , Government of Ghana, 29 Nov 2018

Guinea

Kenya
Women-Run Sexual Reproductive Health Initiatives Win Big , East Africa Business Week, 30 Nov 2018
Lobby in defence of Marie Stopes , The Standard, 30 Nov 2018
Ministry to Probe Teenage Pregnancies, Daily Nation, 16 Nov 2018
Alarm over high teen pregnancies in Isiolo, Daily Nation, 6 Nov 2018

Malawi

Mauritius

Morocco

Niger

Nigeria

Republic of Congo
Santé de la reproduction : les lycéens sensibilisés à la lutte contre les grossesses précoces, Agence d’Informnation d’Afrique Centrale (ADIAC), 22 Nov 2018

Rwanda
How Rwanda can reduce fertility rate , The New Times, 16 Nov 2018
Planification familiale: le Rwanda, l’exemple à suivre, Agence de Presse Senegalaise, 12 Nov 2018
Un centre ado Rwandais érigé en modèle de gestion de la SRAJ, Agence de Presse Senegalaise, 12 Nov 2018
Family planning is in your best interest!, The New Times, 12 Nov 2018

Senegal

Sierra Leone

South Africa
Abortion stigma still rife, City Press, 28 Nov 2018
Women must make own choices on abortion, Gender Links, 27 Nov 2018

Tanzania

Tunisia

Uganda
UNFPA asks Abim to account for Shs36m, Daily Monitor, 27 Nov 2018
22% of teenagers have had sex - government, Daily Monitor, 27 Nov 2018
Back door abortions thriving in Kampala, Daily Monitor, 2 Nov 2018

Zambia

Zimbabwe
African News References - October
The news from 22 countries. We are always interested to hear your feedback and suggestions about relevant news and new sources.
Benin

Botswana

Burkina Faso

Cameroon

Cote d’Ivoire

DRC

Ethiopia
The implementation of safe abortion services in Ethiopia, International Journal of Obstetrics & Gynecology, 30 Oct 2018

Egypt

Ghana
Unsafe Abortions Soar…In Ghana , Peace FM, 31 Oct 2018
Implementing safe abortion in Ghana: “We must tell our story and tell it well” , International Journal of Obstetrics & Gynecology, 30 Oct 2018
GHS supervises more abortion cases in 2017 , Ghana News Agency, 3 Oct 2018

Kenya
Elizabeth: I made the right choice , Naya Kenya, 22 Oct 2018
Kenya tops East Africa in contraceptive use , Business Daily, 22 Oct 2018
I Am 2.0 , I Am 2.0, 22 Oct 2018 (see related video )
World Contraception Day celebration at Kisumu County , Duke Center for Global Reproductive Health, 10 Oct 2018
My Abortion Story, IPPF, 28 Sep 2018

Lesotho

Madagascar

Malawi

Namibia

Nigeria
Nigeria denies plans to limit child births , The Guardian, 24 Oct 2018
Stakeholders want family planning, others in info platforms , News Agency of Nigeria, 23 Oct 2018
Checking population explosion , Sun News, 17 Oct 2018
Religious leaders' support may be key to modern contraception , EurekAlert/JHU Bloomberg School of Public Health, 16 Oct 2018 (For research, see: Role of Religious Leaders in Promoting Contraceptive Use in Nigeria: Evidence From the Nigerian Urban Reproductive Health Initiative , Global Health: Science and Practice, October 2018)
Family Planning And Poverty Reduction, Leadership/Society for Media Advocacy On Health, 6 Oct 2018

Rwanda
Government drafts guidelines on abortion , The New Times, 11 Oct 2018
Introducing World Vasectomy Day 2018 Rwanda!, World Vasectomy Day, 27 Sep 2018

Senegal
Why Infanticide Is A Problem In Senegal, NPR Goats and Soda, 3 Oct 2018

Sierra Leone

South Africa
Decriminalisation of Abortion, Medical Abortion and Advocacy for Change – Conference Report , International Campaign for Women's Right to Safe Abortion, 28 Oct 2018

Tanzania

Uganda
Why a family planning method may fail , Daily Monitor, 29 Oct 2018
Government Urged to Popularize Family Planning , Chimp Reports, 26 Oct 2018
Uganda’s untold abortion story , The Observer, 24 Oct 2018
Ex-VP Kazibwe urges families on planning , New Vision, 22 Oct 2018
43,000 condoms distributed in Kiryandongo , New Vision, 19 Oct 2018
Agago top in teenage pregnancies - report, Daily Monitor, 4 Oct 2018
Businesswoman held over abortion, New Vision, 2 Oct 2018, Washington Post, 10 Oct 2018
When a teenager is denied care..., Health Gap, 28 Sep 2018

Zimbabwe
Post abortion drugs in short supply , Daily News, 27 Oct 2018
NGO tackles teen pregnancies , The Herald, 22 Oct 2018
Teacher rapes, tricks victim into abortion , Nehanda Radio, 12 Oct 2018
‘No birth control pills shortage’ , The Herald, 8 Oct 2018
Zim contraceptive prevalence rate hailed , The Herald, 2 Oct 2018
Family Planning Learning Resources - UPDATED
Additional learning resources, including instructional videos and University of Michigan OB-Gyn Grand Rounds have been added. Click on the icon below for more:
Research resources can be found on the Taubman Health Sciences Library Open Access Research Guide, including:

  • RSS feeds to keep current in the biomedical and health sciences literature
  • Research and clinical (point of care) databases
  • Selected open access journals
  • Freely available online health sciences books
  • Health and epidemiology data sources
  • Evidence-based medicine (EBM) guides and resources
  • Selected freely available health-related mobile resources

The objective of the guide is to be a starting point for use of evaluated information resources in education, research and practice, and not a exhaustive content repository.  
Research and Resource References - October and November

Missed opportunities in women's health: post-abortion care , The Lancet Global Health, 29 Nov 2018


DecidoYo , DecidoYo, 19 Nov 2018

Abortion Story Map , The Abortion Diary, 19 Nov 2018







FP2020 Catalyzing Collaboration , FP2020, 12 Nov 2018











From harm reduction to legalization: The Uruguayan model for safe abortion , International Journal of Obstetrics & Gynecology, 30 Oct 2018

Abortion as a human right: The struggle to implement the abortion law in Colombia , International Journal of Obstetrics & Gynecology, 30 Oct 2018

Realizing abortion law and policy reforms: Lessons from six country case studies , International Journal of Obstetrics & Gynecology, 30 Oct 2018



Factors influencing male participation in reproductive health: a qualitative study , Journal of Multidisciplinary Healthcare, 23 Oct 2018

Abortion "reversal" legislation and science clash , Univadis/New England Journal of Medicine, 19 Oct 2018




Five actions for choice , UNFPA, 16 Oct 2018


The Fake Clinic Database , Reproaction, 12 Oct 2018



WMA statement on medically-indicated termination of pregnancy , World Medical Association, 9 Oct 2018












Ungagging abortion: safe abortion in the context of HIV , International HIV/AIDS Alliance, August 2018
Global and General News References - October and November
Why Are Young People Having So Little Sex?, The Atlantic, December 2018
Abortion Pills Are No Post-Row Panacea , The New York Times, 26 Nov 2018
CJP to lead awareness campaign for family planning , The International News (Pakistan), 24 Nov 2018
Implant use increases by 400pc in 10 years, The Himalayan Times, 18 Nov 2018,
No-Scalpel Vasectomy fortnight from Nov 21, The Tribune (India), 18 Nov 2018
Building Support for Safe Abortion in Asia, One Network at a Time, International Women’s Health Coalition, 9 Nov 2018
Mid-Term Elections Limit Abortion for Some While Ensuring Access for Others, National Partnership for Women and Families, 9 Nov 2018
Norway plays politics with abortion laws , EU Observer, 30 Oct 2018
Avorter à Monaco ? C’est interdit. , France Info, 29 Oct 2018
Reducing Abortion Stigma , IPPF, 25 Oct 2018
The Health Department’s Christian Crusade , Rolling Stone, 24 Oct 2018
What New Yorkers Don’t Know About Roe , The Cut/New York Magazine, 24 Oct 2018
Sharing my abortion secret - Talk It Out , BBC Africa, 23 Oct 2018
“Now I Use Contraception” – Oun Srey Leak’s Story , Girl’s Globe (Cambodia), 23 Oct 2018
Vindication of Pleasure , Repros Fight Back, 23 Oct 2018
Colombia’s Constitutional Court Defends Abortion Rights , International Women’s Health Coalition, 22 Oct 2018
Population explosion a ticking time bomb , Business Recorder (Pakistan), 21 Oct 2018
The Big Cosmopolitan Contraception Survey , Cosmopolitan, 19 Oct 2018
Nepal Enacts Legislation to Protect Women’s Rights to Bodily Autonomy , Center for Reproductive Rights, 19 Oct 2018
Jordan – Roundtable and position paper on abortion , Intyernational Campaign for Women’s Right to Safe Abortion/Share-Net Jordan, 19 Oct 2018
Why abortion vote is a win for human rights , Medical Observer (Australia), 19 Oct 2018
For a safe abortion with pills , Aid Access, 16 Oct 2018
Has Indonesia forgotten contraception? , Indonesia at Melbourne, 16 Oct 2018
Implement sex education without delay , Malay Mail, 15 Oct 2018
Male Contraception: Will It Work? , Medscape, 15 Oct 2018
State cancels health contracts with anti-abortion Heidi Group , Texas Tribune/Longview News-Journal, 12 Oct 2018
Pregnant mother flees to NZ to avoid forced abortion , Radio New Zealand, 10 Oct 2018
Too many people , The International News (Pakistan), 8 Oct 2018
What does Maya say on abortion? , Daraj (Lebanon), 8 Oct 2018
Abortion and freedom of conscience, The Irish Times, 2 Oct 2018
‘Educate women to stop population soaring’, The Nation (Pakistan), 1 Oct 2018
CCP Launches Health Website for Indonesian Youth, John’s Hopkins CCP, 1 Oct 2018
Safe Abortion Care in Humanitarian Settings, Action Canada for Sexual and Health Rights, 1 Oct 2018
An Abortion Story, Nem Presa Nem Morta (Brazil), 28 Sep 2018
Thoughts after World Contraception Day, This is Africa, 27 Sep 2018
Points of Impact: Michelle Moniz, University of Michigan IHPI, 27 Sep 2018
I’ve seen with my own eyes, safe abortion saves lives, Medecins sans Frontieres, 26 Sep 2018
Why Trust Women, Catholics for Choice, 25 Sep 2018
4,000 Years of Abortion History, The Nib, 19 Sep 2018
A Birth Plan for Dying, Longreads, September 2018
Reproductive Health Professionals Changing Lives