Warrior Prose

I find it ironic that as a student studying health promotion and education that I cannot do as I teach because I lack health insurance coverage. I figured that as a young health person with my knowledge level, I could forgo health insurance until I graduated and obtained a real job. Well, I was wrong. Two weeks ago I was rushed to the emergency room because I lost mobility from my chest down.The paramedics and doctors attributed my symptoms to “stress”. As my symptoms worsened while I laid in the hospital bed, no one was able to give me a definite answer.While in the hospital, I had every lab imaginable done. I also had a cat scan, an MRI, an EKG, an EEG, a chest x-ray, and a spinal tap. I was also seen by five separate doctors. With every test coming back normal the doctors (except for one) attributed my symptoms to “stress”.

During my four day hospital stay, I was scarcely seen by the attending physician. And when I did see him, he simply said to my husband and I that I was not going to die from my symptoms. I was bathed only once. I was pushed down on a bed and told to “calm down” while I was having an uncontrollable muscle spasm. I was asked if I spoke English. I was mimicked and laughed at. I was put on a diabetic meal (though not allowed to eat) and had my blood sugar tested four times a day even after I told the nurses I was not diabetic. I pulled my own ivy line out of my arm because the pain was unbearable after waiting over 10 minutes and telling two nurses and the tech. The excuse that was given was that my nurse had to see other patients. My bladder was bloated from the pressure of the catheter because no one had come to check on me for a long period of time.

My husband took better care of me during my hospital stay than the nurses. He took care of my bag. He fed me. He moved me into different positions on the bed to prevent bed sores. He exercised my legs.

I was eventually discharged from the hospital, but without seeing my case worker. I was sent home with nothing. Absolutely no resources. The nurse expected me to get up and walk out of the hospital even though I had only regained slight mobility in my arms and even less in my legs. She did not believe that I needed a wheel chair or a shower seat. The nurse sent an occupational therapist in to make recommendations for me, because, perhaps I was not trying hard enough.

Needless to say, my husband and I are looking into purchasing health insurance coverage and with the help of family we may be able to afford it. I have never felt less like a human being than during this experience. I hope no one else has to go through this type of treatment. It really tears at your soul. And even I at some points doubted my worth as a person in that hospital bed. I do not have to imagine how something like this can make a negative and lasting impression on someone’s life.

- Lona Loudon

I came home to Portland, Oregon for winter break from graduate studies at the University of Chicago. It was nice to go home during this time because both of my younger sisters also were away for college.  A couple days before Christmas we went shopping, buying presents at the last minute and catching up as sisters do. When we got home, the house was empty and there was a message on our answering machine from our aunt. She said that our dad was in the hospital and that he suffered a heart attack. We went numb and rushed to the hospital. We were wondering what happened and how bad was this.

At the hospital, the doctor told us how bad it was. There were three blocked arteries, two at 90% and Dad would have to go into emergency surgery early tomorrow for bypass. I think one of my sisters was sobbing. I could barely hear the doctor, but he said something like my dad should have followed his primary doctor’s orders and taken his medications. I thought this was odd that he was blaming my parents because knowing my very traditional Asian parents, they would do pretty much what their doctors said. It was just as likely that the primary doctor had misdiagnosed my dad’s level of risk. Being distraught and distracted, I put my frustrating thoughts aside. We had to go visit my dad before his surgery and I had to be brave.

He looked so much more frail than I had ever seen him as he laid between the railings of the hospital bed with his gown. He had needles and wires around him. I think some of us sobbed. I tried to keep it together for him. The doctor started to explain more about the surgery and what would happen with the bypass. There was an interpreter there in the corner and the doctor looked towards her and then she’d talk to us. As the doctor continued to talk, I noticed that he never really talked to us, only the interpreter as if she was a member of our family. Actually, I felt as if we were secondary, an after thought to the doctor. Again, I was so out of it that I all I can do was hear what the doctor was saying let alone advocate for my family and myself. I felt like saying to the doctor, “Excuse me, but we’re over here. Actually, if you tried to find anything about us, you’d find that this man on the hospital bed has three college educated daughters who can understand everything that you are saying. We can even translate for our mom as we have done all our lives, too.” But I was exhausted and the discussion was over very fast.

After my dad recovered, I wanted to write to the hospital and doctors to tell them thank you for everything they did for him, but I also wanted to tell them how much more painful it was for me to go through it when the ignored or failed to understand me or my family.

A story of a single Hmong man in Fresno, June 2008, a 21 years old had appendicitis with no private and medical health insurance.  He and his parent believed that it was a stomach flue or typical stomach after eating some unusual foods.  Because the young man does not have medical or private health insurance and have no access to any medical care resources, they kept treating him with herbal medicine such as traditional herbs and stomach massage.  This had been going one for over two weeks.  Due to very serious pain, they took him to the emergency room.  ER doctor checked and found that the appendix was ruptured and the messes already poisoned his blood system.  He finally died at age 21.

- Anonymous

i’m a research consultant for a foundation and work pt as a professor in ethnic studies at UC Berkeley. (got my PhD in 2006) Nope, no health care, just two part time jobs. 35 years old, make good money, but can’t keep up with the paperwork, or the expense, of health care.

in terms of affordability, i remember clearly when i was a student, the only options for me to get an abortion would have been to go to clinic nearly 2 hours by public transit from here.  and pay $500+. As a graduate student, i had no money to pay for these services nor did i have access to a car. i broke into tears at the doctor’s office. a nice chinese lady too. there was so much fear and shame around the abortion, i didn’t know who i could talk to, and i definitely did not have any money to pay for the operation. luckily there was a local community-based women’s clinic that charged me less than $100, but that was clearly not covered by my student health insurance. i managed to put together the money for that payment, but … it was already a hard enough decision, a hard enough situation, that having to worry about money and while having health coverage of some sort … i can’t imagine that situation now that i don’t have health insurance and that women’s clinic has closed because the state won’t pay the bills they owe to the clinic …

~ diana

By Lucy Zhou, NAPAWF Intern

One of the main characters in Disney/Pixar’s latest film, Up, is an 8 year old boy named Russell—and quite shockingly, he’s Asian American.

Like me, you may have had no idea from the trailers, which did not pay much attention to Russell’s ethnicity at all. Moreover, the news media didn’t have much to say about it, in contrast to the extensive marketing and media hype surrounding The Princess and the Frog, an animated film slated to come out this December featuring Disney’s first ever African American princess. Despite my initial disbelief, various sources have confirmed Russell’s race: not only is Russell voiced by Japanese American Jordan Nagai, Up directors based Russell’s character on Korean American Pixar animator Peter Sohn.

This is big news, especially in a society where APIs rarely, if ever, play lead roles in mainstream media. Too many films and TV shows simply relegate API actors to stereotypical stock characters: antisocial nerds, hypersexual females, effeminate males, or martial arts masters, complete with familial conflicts, identity crises and broken English.

Even films intended for API characters end up with whitewashed casts: take 21, the 2008 film inspired by the best-selling book, Bringing Down the House. Although the real-life students on which the story was based were mostly APIs, white actors Jim Sturgess and Kate Bosworth were cast in the lead roles, while minor roles were given to Aaron Yoo and Liza Lapira as apparent visual lip service.

Or take the upcoming 2010 film Avatar: The Last Airbender, based on the Emmy-nominated Nickelodeon series. The show draws heavily from Asian cultures, which is obvious not only visually, but also through explicit statements by the show’s creators.  The initial unveiling of the actors, however, revealed an all white cast. Due to scheduling conflicts, Jesse McCartney has since withdrawn from the cast, with Slumdog Millionaire’s Dev Patel stepping in to play Prince Zuko. Patel is currently the only actor of Asian descent in the main cast—and coincidence?—he plays the villain.

Given this backdrop, Russell’s character in Up is quite extraordinary: not only is he one of the protagonists, he also comes free of the “racial baggage” that typically plagues API film and TV characters. At first, the lack of attention given to Russell’s ethnicity left me feeling bitter—perhaps the studio executives purposely downplayed Russell’s race out of fear that identifying him as an API would make him “unrelatable” to the general American public (a la MTV’s cautious promotion for Better Luck Tomorrow). But after watching the film last Thursday with some of my NAPAWF co-workers, I realized I have been waiting for a film like this for a long time—a film where an API lead isn’t defined by his or her race.

In an interview with Up’s director Peter Docter, he explains that they had considered making Russell’s race a story point, but ultimately decided against it: “I think by not dealing with it it’s more color blind or accepting or whatever, you just cast that character and move forward.”

Russell, then, is not an “Asian American boy”—he’s just a boy, and he represents a significant step in the right direction for API representation in the media. I hope what draws people to this film are the characters and the imaginative story, and that race is neither a detracting nor a selling point. Up would undoubtedly be a remarkable film even if Russell were not of Asian descent. But for me, it certainly is a bonus.

Lucy Zhou is supported by the Civil Liberties and Public Policy Program.

ACTION ALERT: Submit your own comment to the CDC in support of the proposed Criteria for Vaccination Requirements for U.S. Immigration Purposes using the below model comment. Comments must be received on or before May 8, 2009 by 11:59 pm EST. Comments can be submitted via email to DGMQpubliccomments@cdc.gov OR mailed to the below address.

May 8, 2009

Division of Global Migration and Quarantine
Centers for Disease Control and Prevention
U.S. Department of Health and Human Services
Attn: Immigration Vaccination Requirements
1600 Clifton Road, NE., MS E-03
Atlanta, Georgia 30333

RE: Criteria for Vaccination Requirements for U.S. Immigration Purposes

[ORGANIZATION NAME] write to express our support for the Proposed Criteria for Vaccination Requirements for U.S. Immigration Purposes. [ORG MISSION]

I. Introduction:

The Advisory Committee on Immunization Practices (ACIP), a subdivision of the Center for Disease Control and Prevention (CDC), recommended in 2007 that Gardasil be administered to females ages 11 to 26 in the U.S. This recommendation became an automatic requirement for prospective immigrants when the government updated its vaccination list in July 2008 pursuant to Section 212 of the Immigration and Nationality Act (INA) which mandates that “an alien who seeks admission as an immigrant, or who seeks adjustment of status to one lawfully admitted for permanent residence” receive “vaccinations against vaccine-preventable diseases recommended by the [ACIP].”¹

The HPV vaccination requirement and the serious financial and procedural barriers it can create for immigrant applicants are problematic. However, we are greatly encouraged that the CDC has responded to public concerns by developing the proposed Criteria for Vaccination Requirements for U.S. Immigration Purposes. As outlined below, we believe that the new criteria will reverse the HPV vaccination requirement for immigrants and alleviate the problems that had been created. We urge that the new policy be implemented as soon as possible.

II. Criteria for Evaluating Vaccination Requirements for U.S. Immigration Purposes is Severely Needed

Currently, any ACIP recommended vaccine for the general U.S. population becomes mandatory for immigrants when the CDC updates its Technical Instructions to Civil Surgeons for Vaccination Requirements. As such, the CDC does not have the authority and flexibility to determine that it may be medically inappropriate to mandate an ACIP-recommended vaccine for immigrants.

A scientific, evidence-based approach must include an evaluation of the value of a vaccine for protecting the public health and the health of immigrants. The proposed criteria establish the foundation for an evaluation system that can protect and promote the health of both the public at large and immigrants.

III. Application of the Proposed Criteria is an Appropriate Mechanism to Reverse the HPV Vaccination Mandate on Immigrants

Although the proposed rule does not specifically address the HPV vaccine, it will provide the CDC and USCIS with guidance in determining whether to continue to mandate it. If the rule becomes final, all existing immigrant vaccination requirements will be reassessed against the criteria. If a vaccine does not meet the criteria, it will no longer be mandated for immigrants. We discuss below why the HPV vaccination requirement for immigrants should be reversed and how application of the criteria will accomplish this.

• 1. Why the Human Papillmavirus Virus Vaccine Should Not be Mandated for Immigrants

Unlike the other infectious diseases on the list of required vaccinations, HPV does not pose an immediate threat to public health. Dr. Jon Abramson, former ACIP chairman, has said that Gardasil should not be mandatory because HPV, unlike measles or chicken pox, is transmitted only by sexual contact. Of the 14 required vaccinations for immigrants, 12 are intended to combat infectious diseases that experts identify as highly contagious. Gardasil and the vaccine for shingles are the only exceptions.

Furthermore, while the HPV vaccine is recommended for girls and women in the U.S., it is not currently required of U.S. citizens. Immigrant women should also have the opportunity to make an informed decision about their use of the HPV vaccine, weighing both the potential costs and health benefits of this procedure.

Moreover, the high cost of the HPV vaccine creates an unfair financial barrier for immigrant women. The FDA approved regimen consists of three doses to be administered within six months. At the wholesale cost of $130 per dose, completing the regimen would result in at least $390 in vaccine costs and several visits to the doctor or clinic.² According to a recent survey of all designated civil surgeons in Maine that was conducted to determine the actual cost of receiving the Gardasil shots, the price of the series ranged from $600 to $1000. In addition, immigrant applicants must comply with up to 13 other mandatory vaccinations, and pay application fees amounting to over $1,000.

Waiving the HPV vaccination requirement is difficult and cost-prohibitive. While civil surgeons may apply a no-cost blanket waiver to the HPV vaccination under narrow circumstances, there is a mandatory fee of $565 for individual applicants who oppose vaccines based on their religious belief or moral convictions. We find the cost of the waiver unduly burdensome, and are concerned that immigrants may resort to getting the vaccination in lieu of paying the even more expensive waiver fee. We are equally disturbed by the fact that some young immigrant women have decided to wait until they turn 27 years old to apply for adjustment of status so that they can age out of the vaccination requirement. Immigrant women and their families should not have to choose between delaying progress toward U.S. residency and citizenship, and meeting this burdensome requirement.

• 2. The HPV Vaccine Does not Meet the Proposed Criteria

The HPV vaccine does not meet the CDC’s second criteria that the “vaccine must protect against a disease that has the potential to cause an outbreak” or “the vaccine must protect against a disease that has been eliminated in the United States, or is in the process for elimination in the United States.”

First, the HPV vaccine does not protect against a disease that has the potential to cause an outbreak. HPV is not casually transmitted. To contract the type of HPV the vaccine protects against, there must be direct skin-to-skin sexual contact.³

Second, the HPV vaccine does not protect against a disease that has been eliminated in the U.S. or is in the process of elimination in the U.S. HPV is very common within the general U.S. population.

Because the HPV vaccine does not meet the proposed criteria, the HPV vaccine should no longer be compulsory for immigrants seeking admission into the U.S. or seeking to become permanent residents if this rule becomes final. This change would address concerns voiced by reproductive health, public health, and immigrants rights organizations.

V. Conclusion

In sum, we believe that the proposed criteria reflect an appropriate standard by which to evaluate current and potential mandatory vaccinations for immigrants. We urge you to finalize the proposed rule and implement the proposed Criteria for Vaccination Requirements for U.S. Immigration Purposes as expeditiously as possible.

Sincerely,

 

April 09, 2009

Office of Public Health and Science

Department of Health and Human Services

Attention: Rescission Proposal Comments

Hubert H. Humphrey Building

200 Independence Avenue SW

Room 716G

Washington, DC 20201

Re: Rescission Proposal (RIN 0991-AB49)

Comments of the National Latina Institute for Reproductive Health, the National Asian Pacific American Women’s Forum, the Center for Reproductive Rights, and Other Organizations, In Support of the Department of Health and Human Services’ Proposal to Rescind the Regulation Entitled “Ensuring that Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law.”

Introduction

We, the undersigned organizations write to express our grave concerns about the current regulation entitled “Ensuring that Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices in Violation of Federal Law” (“Regulation”) and to express our support for the proposal to rescind the Regulation. Each of our organizations is committed to ensuring that every woman has access to reproductive health care, placing special emphasis on the needs of low-income women and women of color. Although the Regulation has only been in effect for a few months, it is clear that it detrimentally impacts low-income women seeking reproductive health care, and other vulnerable groups, including those seeking end-of-life care, persons affected by HIV/AIDS, and lesbian, gay, bisexual and trans-sexual individuals. In support of the Rescission Proposal, we highlight below some of the serious flaws in the Regulation, focusing primarily on its impact on low-income and minority women.

The Regulation undermines access to health care in this country. It dramatically expands the reach of federal laws protecting health care workers, rather than simply clarifying and enforcing them. It creates uncertainty in a number of areas, including whether provisions that protect those opposed to abortion services can be relied on to deny certain forms of contraception. The Regulation also creates potential conflicts with other federal laws, including Title VII, which strikes a careful balance between the employees’ right to religious freedom, the rights of employers, and the needs of patients. The Regulation allows a broad range of health care workers, including those only tangentially related to the provision of services, to deny information and access to care.

The Regulation’s most glaring defect is its failure to address, much less mention, the rights and needs of patients. Instead, the Regulation limits a patient’s access to health care, and creates confusion and uncertainty – the problems it will cause for individual patients is nowhere taken into account. Moreover, the cost-benefit analysis included in the Regulation is based on unfounded assumptions and does not even attempt to measure the cost of the Regulation from the “patient” side of the equation.

The Regulation is hopelessly flawed and must be rescinded. Health care providers in this country who entertain religious or moral objections to the provision of certain health care services are already adequately protected by federal law, and are not in need of further protections. On the other hand, low-income women and women of color struggle every day to obtain the health care they need and the Regulation only makes this struggle more difficult. Too much is at stake for the women who will be denied access to critical reproductive health care to continue on this dangerous course set by the Regulation.

The Regulation Should Be Rescinded Because It Undermines Access to Health Care

The Regulation changes three federal laws governing health care refusals in several ways that will negatively impact patients seeking medical treatment and information. The three laws affected by the Regulation are the Church Amendment,[1] the Weldon Amendment,[2] and Section 245 of the Public Health Service Act,[3] all of which already provide comprehensive protection for health care workers who do not want to provide certain services based on their religious beliefs or moral convictions.

A. The Regulation Could Lead to the Denial of Critical Contraception Options

The Regulation creates dangerous uncertainty as to whether health care providers could now rely on federal law permitting conscientious refusals to provide abortion services to deny common forms of birth control, such as the Pill and IUDs. The Department of Health and Human Services (“the Department”) created this ambiguity and the Regulation should be rescinded because it fails to clearly address this issue.

A preliminary draft of the Regulation included a definition of “abortion” that encompassed methods of contraception which can in some instances prevent implantation of a fertilized egg, such as the birth control pill and IUDs. [4] As a result, under the preliminary draft, health care providers were given explicit permission to refuse to provide these forms of contraception on the grounds that they were equivalent to providing abortion services. In the final Regulation, the definition of “abortion” was removed altogether, creating uncertainty as to the extent to which the Regulation expands current federal refusal laws. The suggestion from the preliminary draft that abortion could include some forms of contraception has opened the door for health care entities and individuals to define abortion expansively as a justification for denying care.

The negative impact of the ambiguity over whether federally funded health care providers can refuse to provide contraceptives falls directly on patients, and specifically on low-income women whose only access to prescription birth control is through federal programs such as Medicaid and Title X. While there are legal and administrative procedures in place that will ultimately determine if a health care provider was within its rights to equate contraception with abortion, those processes will not ameliorate the harm done to individual women who have been denied timely access to the birth control option that best meets their needs.

B. The Regulation Extends the Ability to Deny Services to Those with Minimal Connection to Patient Care

The Regulation extends the right to refuse health services to a broader range of workers than previously permitted, including those who are only tangentially related to the provision of health care. The Regulation defines the term “assist in the performance”[5] for the first time, and also defines some of the terms included in this definition and used elsewhere in the statutes, including, “individual,”[6] “workforce,”[7] and “health service/health service program.”[8] In the description of the definition for “assist in the performance,” the Department has previously stated that it “seeks to provide broad protection for individuals’ consciences,” and that it “seeks to avoid judging whether a particular activity is genuinely offensive to an individual.”[9] In defining “health service program,” the Department has stated that it should be understood to “include an activity related in any way to providing medicine, health care, or any other service related to health or wellness…”[10]

By defining all of these terms broadly, the Regulation expands the protection of the Church Amendment to individuals far outside the scope of those who would have reasonably been considered to provide health services under previous law, such as physicians, physician’s assistants, and nurses. These new definitions allow almost any worker in a health care setting to refuse to provide services to a patient based on his or her religious or moral beliefs. Indeed, one of the two examples in the description for the definition of “assist in the performance,” is of an employee whose task it is to clean instruments following a particular procedure.[11] The Regulation thus expands the right to refuse to a range of workers performing a variety of services, such as receptionists who make appointments, claim adjustors at health insurance companies, and custodians who work in clinics and hospitals. Under the Regulation, health care institutions could struggle to effectively provide care, and women could be delayed or even prevented from receiving reproductive health care.

The Regulation’s extension to the actions of such a broad range of non-medical personnel who “assist in the performance of” objectionable procedures clearly illustrates its lack of consideration for the needs of patients. In no other area of medicine are tangentially related individuals allowed to interfere with the provision of services in a way that may delay or deny health care. The Regulation goes too far in extending the right to deny services to individuals who are marginally related to the medical care being provided. This broad expansion could lead to serious disruptions in care and hamper the ability of health care institutions to meet the needs of patients. Once again, the Regulation tips the balance perilously away from what is best for patients, and for this reason it should be rescinded.

C. Inclusion of Counseling and Referrals in Federal Refusal Laws Could Deny Patients Timely Access to Care and Information Necessary to Make Informed Health Care Decisions

An additional problem, which justifies rescission of the Regulation is its expansive definition of what conduct amounts to “assisting in the performance” of health care services. This definition is critical because federal law allows health care providers to not only refuse to perform objectionable services, but also to refuse to “assist in the performance” of those services. The definition provided in the Regulation states that “assist in the performance” includes “counseling, referral, training, and other arrangements for the procedure, health service or research activity.”[12] While referrals are already included in the Weldon Amendment and Section 245 of the Public Health Service Act, the Church Amendment does not currently include referrals in its language. The preliminary draft of the Regulation did not include counseling within the definition.

Allowing federally-funded individuals to deny women information and referrals for reproductive health services and other health care options has the potential to eliminate some women’s ability to make informed health care decisions and to provide informed consent. For instance, if health care providers refused to provide information and counseling on the full range of options to pregnant women, including those with fetal anomalies and victims of rape and incest, those women would not be able to provide informed consent for related health procedures. Women might also be denied information about the possibility of using some forms of contraception to control their reproduction, or prevent other health problems, and may not be informed of the possibility of using emergency contraception to prevent unwanted pregnancies.

Additionally, certain types of services, such as end-of-life care, may now be included based on the new definition of “health service program.” The inclusion of counseling and referrals in the definition of “assist in performance” would allow health care providers to deny dying patients the full range of information about their options.

A particularly troubling aspect of the Regulation is its silence regarding Title VII, the federal law that provides protection to employees’ religious beliefs, while at the same time establishing that employers need only make “reasonable accommodations” in respecting those beliefs. [13] The concerns raised by the expansion of the range of health care workers who may exercise conscientious objection and the expansive definition of “assisting in the performance,” are heightened by the fact that the interaction of the Regulation with Title VII is not explicitly addressed. The Regulation should therefore be rescinded.

The Regulation’s Impact on Low-Income Women and Women of Color

A. A Disproportionate Number of Low-Income Women and Women of Color Use Public Health Care and Will Be Adversely Affected By the Regulation.

A disproportionate number of low-income women and women of color rely on public health care programs. In the U.S., where access to health care depends on insurance coverage, lack of health insurance is the primary barrier to receiving reproductive health care. Overall, the number of people enrolled in public health insurance programs is decreasing and private insurance coverage continues to shrink.[14] Hence, a greater number of low-income people lack insurance of any kind because they do not have employer-based coverage and do not qualify for public insurance. Women of color, who disproportionately work in low-wage jobs that do not offer benefits,[15] have lower rates of insurance coverage: 39% of Latinas, 19% of API women, and 18% of African-American women are without affordable health care compared to only 10% of white women.[16]

Without affordable health care, these women turn to public programs such as Medicaid and Title X of the Public Health Service Act (Title X). Medicaid covers all prenatal and pregnancy-related care for eligible women. As of 2005, women of reproductive age (15-44) comprised 11.5% of U.S. women covered by Medicaid,[17] many of whom are women of color. In 2006, women of color made up 51% of non-elderly Medicaid beneficiaries, but less than 20% of the general population.[18] In addition, Title X, a program that funds reproductive health clinics that provide contraceptive services and supplies, STI testing and treatment, and preventative screenings, benefits 6.6 million low-income women, 40% of whom are women of color.[19]

B. Impact of the Regulation on Low-Income Women and Women of Color

Women of color are disproportionately affected by the Regulation because many of them rely heavily on federally-funded health care programs. As noted, the Regulation creates three significant problems: that “abortion” may be broadly defined to include contraception; that a broad range of individuals can refuse to “assist in the performance” of a health service; and that clinics can withhold information and deny informed consent. All these problems directly affect low-income women and women of color.

The Regulation allows a clinic worker to refuse to assist in the performance of a health service if it is “contrary to his religious beliefs or moral convictions.” Some individuals conflate contraceptive use with abortion and therefore deem it morally wrong. However, in 2004, women attending publicly funded clinics avoided an estimated 1.4 million unintended pregnancies and the decline in unintended pregnancies over the years is largely attributed to the availability of contraceptives.[20] If the Regulation is not rescinded, clinics may refuse to distribute some contraceptives to patients, a large proportion of whom are low-income women and minority women.

The Regulation also allows a broad range of individuals to refuse to “assist in the performance” of a health service if they find it contrary to their religious beliefs or moral convictions. As stated above, this suggests many scenarios that could affect a woman’s reproductive health. For instance, a receptionist may refuse to make an appointment for an individual seeking contraceptives or a nurse may refuse to sterilize equipment used in the performance of abortion. Hence, there is not only a danger that many low-income women and women of color who go to public health clinics to seek contraceptives or reproductive health options may be turned away, but also the creation of potential health hazards to the patients.

In addition, the Regulation allows clinics to withhold information and deny informed consent, which directly contradicts the requirement to provide information and counseling on prenatal care and pregnancy termination set forth in Title X.[21] Under the Regulation, health care centers and institutions could not only refuse to give information about abortion or contraceptives, but also refuse to refer their patients to someone who will answer those questions.

The impact of the Regulation falls most heavily on low-income women seeking abortions in federally-funded health care settings. More than one in three American women will seek an abortion within her lifetime.[22] When low-income women, non-English speakers, rural women, and women who depend upon public transportation seek abortion services, they often face significant obstacles associated with missed work, child care, and other logistics, such as transportation. If these women are then turned away from health care providers, they may not have the resources to locate another provider and make their arrangements a second time.

The Regulation also affects low-income women’s ability to access health care services outside of reproductive health. Many low-income women already experience discrimination in the health care system based on their inclusion in a specific class of persons, such as those with HIV/AIDS, those of a certain race or ethnicity, or based on immigration status. Because the regulation expands the types of workers covered and types of services that can be denied under federal refusal laws, discrimination against persons in those vulnerable groups could increase.

Moreover, because it does not provide a definition of “moral convictions,” the Regulation could create avenues for providers and entities to refuse services or information because of discrimination, self-interest, or distaste for certain procedures. This creates a unique problem for low-income women and women of color. They may be easily discriminated against due to their socioeconomic status, gender, sexual orientation, or race under the guise that the action to be taken is contrary to the providers’ “moral convictions.” For example, a same-sex couple could be denied infertility services.[23]

Thus, the Regulation creates a myriad of ways for health care institutions and individuals to refuse to provide health services and/or information or referrals. It is clear that these issues will directly affect low-income women and women of color because many of them rely on public health programs for these services.

The Regulation Does Not Meaningfully Address Important Issues of Diversity in the Workplace

The text of the Regulation discusses “an environment in the health care field that is intolerant of individual conscience” as a factor that may discourage diversity in the health care workforce, claiming that people of various religious, ethnic and cultural groups might be excluded without this regulation in place. This claim is misguided in several ways.

First, the implication that religious, ethnic and cultural minorities feel a specific way regarding reproductive health services is a simplistic and inaccurate generalization. Communities of color have been and continue to be instrumental in the fight for access to reproductive health care, and to imply that these communities are opposed to basic reproductive health procedures on a larger scale than other communities is an unfounded assumption.

Second, the notion that making it easier to refuse to provide services will diversify the health care workforce is questionable at best. While diversifying the health care workforce is a commendable objective, and one that is sorely needed ─13% of the United States population identifies as Latino/a and 12% identify as Black,[24] but only 6.4% and 6.5% of medical school graduates in 2004 were Latino/a or Black, respectively,[25] and only 2.8% and 3.3% of physicians practicing in 2004 were Latino/a or Black, respectively[26]─ the Regulation does not accomplish this objective. Diversifying the health care workforce would mean establishing a pipeline for minority physicians, researchers, and other health care professionals through the elimination of obstacles that communities of color face in educational attainment. Some ways these obstacles can be addressed include the creation of federal and state funded scholarships, loan forgiveness, mentoring programs for young people of color, tuition assistance, increased financial aid and affirmative action; it is steps like these that truly begin to eliminate the barriers to a diverse health care workforce.

Another area of concern is that the Regulation takes no account of diversity among patients. The Regulation is written broadly enough so that health care workers may not only refuse to participate in particular procedures, but also refuse to treat particular groups of people. This kind of ‘moral’ refusal is not unheard of. Lupita Benitez was refused artificial insemination by two physicians in her provider network because she is a lesbian, Not only did she have to incur the monetary costs of an out-of-network provider to receive the insemination during the critically short fertility time window, she also had to endure the emotional burden incurred due to this kind of discrimination.[27] The Regulation seems to condone and encourage this kind of discrimination, the brunt of which will be felt by visible minorities and marginalized populations, such as LGBT people, undocumented people, immigrants, and people living with HIV/AIDS. Whether these actions are actually within the realm of the law will be of little relevance to the countless patients whose health will suffer due to the refusal of treatment that this Regulation will foster.

The Regulation Creates a Culture of Refusal

In addition to the specific concerns detailed above, the Regulation also further exacerbates the imbalance between the rights of conscience and women’s rights to reproductive health care. The Regulation is intended to expand a network of federal and state conscientious refusal laws that have created a “culture of refusal,” in which women’s reproductive health care needs and rights are accepted as being secondary to the conscience of providers. These laws often ignore health care providers’ responsibilities and ethical duties to provide care to patients in a way that is respectful of patient autonomy, timely, effective, evidence-based and non-discriminatory.[28] Instead, together with numerous other federal and state laws, they are politically motivated attempts to prevent women from accessing abortion and family planning services that use conscience as a smokescreen for their goals.

Refusal laws exist in significant numbers at the federal and state levels. As noted, the Church Amendment,[29] the Weldon Amendment, [30] and the Public Health Service Act Sec. 245[31] already provide strong protection for individual health care providers and institutions to exercise their religious or moral beliefs regarding reproductive rights. These laws, along with Title VII,[32] already allow individuals, health care entities, and research programs that receive federal funding to refuse to participate in or provide training for abortions, sterilizations, and in some cases any activity that is contrary to their moral convictions or religions beliefs.

Additionally, nearly every state has a policy explicitly allowing some health care professionals or certain institutions to refuse to provide or participate in abortion, contraceptive services or sterilization services. Forty-six states allow some individual health care providers to refuse to provide abortion services, and forty-three of those states allow health care institutions to refuse to provide abortion services.[33] Thirteen states allow some individual health care providers to refuse to provide services related to contraception and nine of those states allow health care institutions to refuse to provide services related to contraception.[34] Seventeen states allow some health care providers to refuse to provide sterilization services and fifteen of those states allow health care institutions to refuse to provide sterilization services.[35] Even in states without explicit refusal statutes, an individual health care professional’s actions may be legally protected by statutes prohibiting discrimination against employees, based on their religious objections.[36]

Expanding the culture of refusal, as the Regulation does, has a particularly severe impact on women of limited means, who are disproportionately women of color in this country. These women already face significant barriers in accessing health care overall, even without the added difficulties created when providers in under-resourced communities refuse care to women. The United States Office of Women’s Health found “[s]everal…factors limit the access of minority women to the U.S. health care system. They include social disadvantages, cultural values, discrimination, lack of culturally appropriate services, inadequate childcare, and transportation…”[37] Additionally, a study by the Kaiser Family Foundation found that low-income women faced twice as much difficulty as other women in obtaining the flexible work schedules, transportation, and child care necessary to access health care services for themselves.[38]

The existing barriers that women face in accessing health care become especially burdensome when coupled with refusal clauses as sweeping as those in the Regulation. As the American College of Obstetricians and Gynecologists recently recognized, when low-income women and minority women are refused services, turned away, or given incomplete information about their reproductive health care options, they often do not have the opportunity to access other health care providers. “For instance, a refusal to dispense contraception may place a disproportionate burden on disenfranchised women in resource-poor areas. Whereas a single, affluent professional might experience such a refusal as inconvenient and seek out another physician, a young mother of three depending on public transportation might find such a refusal to be an insurmountable barrier to medication because other options are not realistically available to her.”[39]

The Regulation also puts the United States increasingly out of step with international human rights standards and norms. International standards require a balance between health and conscience and require a recognition that health is of primary importance.[40] So, while practitioners have a right to respect for their conscientious convictions and should not suffer from discrimination on the basis of their convictions, refusal clauses must reflect prevailing standards of medical ethics that make patient’s health care of primary consideration. Refusal clauses cannot be overbroad: only those providers participating in the procedure may object, not those providing care before or after, or those performing administrative services.[41] Providers must promptly tell patients that they refuse to provide certain health services and patients are entitled to be referred immediately, in good faith, for procedures that providers object to undertaking.[42] Despite growing international consensus on these standards, none of these protections for patient care are included in the Regulation.

The Cost-Benefit Analysis Purporting to Support the Regulation is Inadequate.

The cost-benefit analysis conducted by the Department was poorly performed and therefore provides no reliable information on the Regulation’s actual impact. As described in greater detail in the attached analysis prepared by the Institute for the Study of Regulation at the New York University School of Law (“ISR Analysis”):

The Department has engaged in an incomplete, cursory, and inadequate cost-benefit analysis in support of the proposed rule. First, the rule fails to prove the existence of the problem it is designed to solve. Second, the analysis fails to quantify benefits of the regulation. Finally, the analysis fails to identify and account for serious costs arising from, inter alia, potential failures to inform women of their health choices and a decreased availability of medical procedures and/or contraception. The analysis performed by the Department falls below a reasonable standard of an appropriate cost-benefit analysis as required by EO 12,866. Accordingly, this flawed cost-benefit analysis cannot be used to justify the promulgation of the proposed rule. Under EO 12,866, the Department is obligated to undertake a more formal accounting of the impacts of the proposed regulation in economic terms.

Of particular concern is the Department’s failure to adequately address the costs associated with the Regulation, and in particular its impact on subgroups including low-income women and women of color. As the ISR Analysis points out, the Department is required “to assess how the costs and benefits are distributed among subpopulations.” In spite of this mandate, the Department’s cost-benefit analysis makes no attempt to assess the impact on these vulnerable groups.

Given the gravity of the interests at stake – access to health care by low-income women and women of color who already disproportionately experience poorer reproductive health – the failure of the Department to meet its obligation to undertake a well-conducted and balanced cost-benefit analysis is reason enough to rescind the Regulation.

Conclusion

Women seeking reproductive health care services already face tremendous obstacles. If left in place, the Regulation will exacerbate those problems. For all of the foregoing reasons, we urge you to rescind this dangerous and misguided regulation.

Sincerely,

National Latina Institute for Reproductive Health

National Asian Pacific American Women’s Forum

Center for Reproductive Rights

---

 

[1] 42 U.S.C. §300a-7 (2008).

 

[2] Consolidated Appropriations Act, 2008, Pub. L. No. 110-161, Div. G, §508(d), 121 Stat. 1844, 2209 (Dec. 26, 2007)

 

[3] 42 U.S.C. §238(n) (2008).

 

[4] The definition proposed in the preliminary draft was contrary to definitions accepted by both the American Medical Association and the American College of Obstetricians and Gynecologists. See, Department of Health and Human Services Proposed Rule at 30; Rachel Benson Gold, Guttmacher Inst., The Implications of Defining When a Women Is Pregnant, 8 Guttmacher Rep. on Pub. Pol’y 7-10, 7-8 (May 2005), available at http://www.guttmacher.org/pubs/tgr/08/2/gr080207.pdf (citing American College of Obstetricians and Gynecologists).

 

[5] “Assist in the Performance” is defined as “to participate in any activity with a reasonable connection to a procedure, health service or health service program, or research activity, so long as the individual involved is a part of the workforce of a Department-funded entity. This includes counseling, referral, training, and other arrangements for the procedure, health service, or research activity.” Ensuring that Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices In Violation of Federal Law, 73 Fed. Reg. 50274, 50282 (August 26, 2008), (to be codified at 45 C.F.R. pt. 88).

 

[6] “Individual” is defined as “a member of the workforce of an entity / health care entity.” 73 Fed. Reg. 50274, 50282 (August 26, 2008), (to be codified at 45 C.F.R. pt. 88).

 

[7] “Workforce,” “includes employees, volunteers, trainees, and other persons whose conduct, in the performance of work for a Department-funded entity, is under the control or authority of such entity, whether or not they are paid by the Department-funded entity.” 73 Fed. Reg. 50274, 50282-50283 (August 26, 2008), (to be codified at 45 C.F.R. pt. 88).

 

[8] “Health Service / Health Service Program,” “includes any plan or program that provides health benefits, whether directly, through insurance, or otherwise, which is funded, in whole or in part, by the Department. It may also include components of State or local governments.” 73 Fed. Reg. 50274, 50282 (August 26, 2008), (to be codified at 45 C.F.R. pt. 88).

 

[9] Ensuring that Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices In Violation of Federal Law, 73 Fed. Reg. 50274, 50277 (August 26, 2008), (to be codified at 45 C.F.R. pt. 88).

 

[10] Id. at 50278.

 

[11] Id. at 50277.

 

[12]Ensuring that Department of Health and Human Services Funds Do Not Support Coercive or Discriminatory Policies or Practices In Violation of Federal Law, 73 Fed. Reg. 50274, 50282 (August 26, 2008), (to be codified at 45 C.F.R. pt. 88).

 

[13] 42 U.S.C § 2000e-1(a) (2008).

 

[14] U.S. Census Bureau, Income, Poverty, and Health Insurance Coverage in the United States: 2006 18-19 (Aug. 2007), available at http://www.census.gov/prod/2007pubs/p60-233.pdf, (showing a decrease from 27.3 million people covered in 2005 to 27.0 covered in 2006).

 

[15] Kaiser Family Found., Racial and Ethnic Disparities in Women’s Health Coverage and Access to Care: Findings from the 2001 Kaiser Women’s Health Survey 2 (Mar. 2004), available at http://www.kff.org/womenshealth/upload/Racial-and-Ethnic-Disparities-in-Women-s-Health-Coverage-and-Access-to-Care.pdf. White women (70%) are more likely to have employer provided health coverage than African American women (59%) or Latinas (39%). Nat’l Inst. of Health, Women of Color Health Data Book: Adolescents to Seniors 107 (2006), available at http://orwh.od.nih.gov/pubs/WomenofColor2006.pdf [hereinafter NIH
Women of Color Health Data Book].

 

[16] NIH Women of Color Health Data Book, supra note 36, at 107; Kaiser Family Found., Women’s Health Policy Fact Sheet: Women’s Health Insurance Coverage 2 (Dec. 2007), available at http://www.kff.org/womenshealth/upload/6000_06.pdf.

 

[17]Kaiser Family Found., and Guttmacher Instit., Issue Brief: A Critical Source of Support for Family Planning in the United States 1 (April 2005), available at http://www.kff.org/womenshealth/upload/Medicaid-A-Critical-Source-of-Support-for-Family-Planning-in-the-United-States-Issue-Brief-UPDATE.pdf..

 

[18] Kaiser Family Found., Issue Brief: Medicaid’s Role for Women 1 (May 2006) available at http://www.kff.org/womenshealth/upload/Medicaid-s-Role-for-Women-May-2006.pdf.

 

[19] Guttmacher Inst., Title X and the U.S. Family Planning Effort 3 (1997), available at

http://www.guttmacher.org/pubs/ib16.html.

 

[20] Heather D. Boonstra, Guttmacher Inst., The Impact of Government Programs on Reproductive Health Disparities: Three Case Studies, 11 Guttmacher Pol’y Rev. 3 at 8, (Summer 2008).

 

[21] 42 C.F.R. § 59.5 (2008).

 

[22] Heather D. Boonstra et al., Guttmacher Inst., Abortion in Women’s Lives 6 (2006), available at http://www.guttmacher.org/pubs/2006/05/04/AiWL.pdf.

 

[23] American College of Obstetricians and Gynecologists, The Limits of Conscientious Refusal in Reproductive Medicine, Committee Opinion Number 385, at 4 (Nov. 2007).

 

[24] U.S. Department of Commerce, Economics and Statistics Administration, U.S. Census Bureau, Census 2000 Brief, Overview of Race and Hispanic Origin 3 (March 2001) available at http://www.census.gov/prod/2001pubs/c2kbr01-1.pdf

 

[25] Association of American Medical Colleges, Minorities in Medical Education: Facts and Figures 2005 at 27 (Spring 2005).

 

[26] Association of American Medical Colleges, Diversity in the Physician Workforce: Facts and Figures 2006, at 15 (Summer 2006).

 

[27] Lambda Legal, Benitez v. North Coast Women’s Care Medical Group Questions and Answers (June 22, 2005), available at http://www.lambdalegal.org/our-work/publications/facts-backgrounds/page.jsp?itemID=31987395.

 

[28] Id. at 3.

 

[29] 42 U.S.C.A. §300a-7 (2008).

 

[30] Consolidated Appropriations Act, 2008, Pub. L. No. 110-161, Div. G, §508(d), 121 Stat. 1844, 2209 (Dec 26, 2007).

 

[31] 42 U.S.C.A. §238(n) (2008).

 

[32] 42 U.S.C § 2000e-1(a) (2008).

 

[33] Guttmacher Inst., State Policies in Brief, Refusing to Provide Health Services Factsheet (Sept. 1, 2008), available at http://www.guttmacher.org/statecenter/spibs/spib_RPHS.pdf.

 

[34] Id.

 

[35] Id.

 

[36] Id.

 

[37] U.S. Dept. of Health & Human Services, Office on Women’s Health, The Health of Minority Women 4 (July 2003), available at http://www.4woman.gov/owh/pub/minority/minority.pdf.

 

[38] Kaiser Family Found., Women and Health Care: A National Profile 24 (July 2005), available at http://www.kff.org/womenshealth/upload/Women-and-Health-Care-A-National-Profile-Key-Findings-from-the-Kaiser-Women-s-Health-Survey.pdf.

 

[39] American College of Obstetricians and Gynecologists, The Limits of Conscientious Refusal in Reproductive Medicine, Committee Opinion Number 385, at 4 (Nov. 2007).

 

[40] International Covenant on Civil and Political Rights, Art. 18, opened for signature December 19, 1966, 999 U.N.T.S. 85 (entered into force March 23, 1976).

 

[41]See, e.g., Janaway v. Salford Health Authority, 2 All E.R. 1079 (H.L. 1988)(conscience objection clause in UK abortion law only applies to participation in treatment); Regulations for the Implementation of the Act dated June 13 1995 no. 50 concerning Termination of Pregnancy, with Amendments in the Act dated 16 June 1978 no. 66 cf. § 12 of the Act, laid down by Royal Decree, 1 December 1978, § 20 (Nor.)(Regulations implementing Norway’s abortion law expressly provide that the right to refuse to assist in an abortion belongs only to the personnel who perform or assist the actual procedure).

 

[42] See, e.g., Code de law Sante Publique, arts. L22212-8 and R4127-18 (Fr.) (2001) (France’s Public Health code places a legal obligation on providers to immediately communicate their refusal to perform an abortion).

March 18, 2009

Richard H. Besser, M.D.
Acting Director
Centers for Disease Control and Prevention (CDC)
1600 Clifton Road
Atlanta, GA 30333

RE: HPV Vaccination Mandate for Immigrant Women and Girls

Dear Dr. Besser:

The undersigned, over 125 immigrants’ rights, women’s rights, public health, medical, and reproductive justice organizations write to urge you to expedite the publishing of the proposed criteria for identifying Advisory Committee on Immunization Practices (ACIP) recommended vaccines as immunization requirements for immigrants in the Federal Register.

At the February 25-26 ACIP meeting, the Division of Global Migration and Quarantine (DGMQ) proposed criteria for identifying ACIP recommended vaccines as immunization requirements for immigrants. We are encouraged by this proposal and feel that it is an appropriate response to the recent controversy surrounding the HPV vaccination mandate on immigrants. We have learned, however, that while the proposal has been drafted for publication in the Federal Register, publication has been stalled.

In our January 26th letter to you (enclosed), we outlined our concerns about the HPV vaccination mandate on immigrants, and would like to remind you of the urgency of the situation. We have received inquiries and reports from concerned families and young women who have opted to postpone their adjustment of status applications in order to avoid compliance with the mandate. Immigrant women and their families should not have to choose between delaying their path toward residency and U.S. citizenship, and meeting this burdensome and unnecessary requirement.

We urge you to act immediately to clear the proposal for publication in the Federal Register and begin the process of correcting this mandate.

Thank you for your consideration. We welcome the opportunity for further communication on this issue. Please contact Priscilla Huang at phuang@napawf.org, or (301) 270-4440, with questions or concerns.

Sincerely,

International Organizations

International Women’s Health Coalition

National Organizations

Advocates for Youth

American Immigration Lawyers Association

American Medical Student Association

American Social Health Association

Americans for Democratic Action

Asian American Justice Center

Asian & Pacific Islander American Health Forum

Black Alliance for Just Immigration

Black Women’s Health Imperative

Center for Human Rights and Constitutional Law

Center for Reproductive Rights

Center for Women Policy Studies

Choice USA

Church World Service, Immigration and Refugee Program

Community HIV/AIDS Mobilization Project (CHAMP)

Gynecological Cancer Foundation

Ibis Reproductive Health

Law Students for Reproductive Justice

Legal Momentum

Migrant Health Promotion

National Advocates for Pregnant Women

Native American Women’s Health Education Resource Center

National Asian American Pacific Islander Mental Health Association

National Asian Pacific American Families Against Substance Abuse

National Asian Pacific American Women’s Forum (NAPAWF)

National Association of Nurse Practitioners in Women’s Health

National Coalition of STD Directors (NCSD)

National Council of Jewish Women

National Council of La Raza

National Health Law Program

National Immigration Law Center

National Institute for Reproductive Health

National Korean American Service & Education Consortium (NAKASEC)

National Latina Institute for Reproductive Health

National Network for Immigrant and Refugee Rights

National Network of Abortion Funds

National Organization for Women

Nonviolent Choice Directory

National Partnership for Women & Families

National Women’s Health Network

OCA Embracing the Hopes and Aspirations of Asian Pacific Americans

Our Bodies Ourselves

Planned Parenthood Federation of America

Pro-Choice Public Education Project (PEP)

Project PAP (Prevention Awareness Program) National Group

Quirky Black Girls

Reproductive Health Technologies Project

SisterSong Women of Color Reproductive Health Collective

South Asian Americans Leading Together

Southeast Asia Resource Action Center (SEARAC)

The American College of Obstetricians and Gynecologists

The MergerWatch Project

The Praxis Project

United Methodist Church, General Board of Church and Society

Women of Color Resource Center

State/Local Organizations

ACCESS/Women’s Health Rights Coalition

Act for Women and Girls

African Services Committee

American Friends Service Committee, Philadelphia, Pa

Asian Law Caucus

Asian Pacific American Legal Center of Southern California

BARCA, Inc.

Biotechnology and Pharmaceutical Law Institute, North Carolina Central University School of Law

California Academy of Family Physicians

California Family Health Council, Inc.

California National Organization for Women

Chicago Abortion Fund

Chicago Women’s Health Center

Coloradans For Immigrant Rights, a project of the American Friends Service Committee Colorado

Colorado National Organization for Women

Colorado Organization for Latina Opportunity & Reproductive Rights (COLOR)

Daya, Inc. (Texas)

Desis Rising Up and Moving (DRUM) (New York City)

Different Avenues

Entre Nosotras Foundation

Farmworker Legal Services of NY, Inc.

Feminist Women’s Health Center

Florida Coastal School of Law Immigrants Rights Clinic

HPV Awareness

Human Rights Initiative of North Texas, Inc.

Illinois Caucus for Adolescent Health (ICAH)

Immigrant Legal Advocacy Project

Immigration Services, Catholic Charities, Archdiocese of Atlanta

Indo-American Center (Illinois)

Jacksonville Area Legal Aid, Refugee Immigration Project

Justice Now

Just Neighbors

Kentucky Health Justice Network

Korean American Resource & Cultural Center (KRCC), Chicago, IL

Korean Resource Center (KRC), Los Angeles, CA

Law Office of Jacqueline Tapia

LUZ: A Reproductive Justice Think Tank

Miami International Latinas Organizing for Leadership and Advocacy (MI-LOLA)

Michigan Asian Indian Family Services (Michigan)

Mitch Factors Innovation in Health & Wellness

Mujeres Latinas en Accion

NARAL Pro-Choice Massachusetts

NARAL Pro-Choice New York

NARAL Pro-Choice Oregon

Narika

Nationalities Service Center

New Voices Pittsburgh: Women of Color for Reproductive Justice

New York City Latina Advocacy Network

Northwest Women’s Law Center

Pinay sa Seattle

Planned Parenthood Los Angeles

Planned Parenthood of New York City

Prax(us)

Refugee Forum of Orange County

Reproductive Justice Collective

Reproductive Justice Committee of the Unitarian Society of Ridgewood (NJ)

Robin H. Thompson & Associates

SisterLove, Inc.

Southwest Women’s Law

Tewa Women United

The Feminist Women’s Health Centers of California

The Institute of Women and Ethnic Studies

The New York Immigration Coalition

UCAN

Victims Resource Center

Women Who Care, Inc.

YWCA of the Sauk Valley

The Feminist Women’s Health Centers of California

The Institute of Women and Ethnic Studies

The New York Immigration Coalition

UCAN

Victims Resource Center

Women Who Care, Inc.

YWCA of the Sauk Valley

NAPAWF does not endorse these events nor the organizations sponsoring them. This listing is for informational purposes only.

International Women’s Day provides an opportunity for communities to come together. It is an important occasion to celebrate the achievements and gains made by women.

AIWA and nine other organizations (including the NAPAWF UMich chapter!) from the Metro Detroit  area are collaborating to provide a great opportunity for women to network and celebrate International Women’s Day.

The celebration will feature Kayhan Irani from New York City as the keynote speaker, a Cultural Fashion Show, and Award Presentation to honor and celebrate local women’s achievements and their continued contributions they make in their community.

At: Philippine American Community Center of Michigan (17356 Northland Park Court, Southfield, Michigan, 48075) Call 248-443-7037 or Arcie at 586-954-9711.
On:  Saturday, March 21st, 2009
Time: 10:00 am to 2:30 pm including lunch

Keynote Speaker: In 2007, “artivist” Kayhan Irani was awarded a Certificate of Recognition by Mayor Bloomberg, as part of Immigrant History Week. Come experience pieces from her one-woman show entitled “We’ve Come Undone,” which highlights the lives of immigrant women post-9/11. Kayhan seeks to activate audiences and transform society through her art.

Limited Seats! Register by March 14th. Tickets are $10.

NAPAWF does not endorse these events nor the organizations sponsoring them. This listing is for informational purposes only.

Date:05 March 2009
Time:19;00 - 21:00
Event: International Women’s Day celebration
About: Join us as we mark this global day connecting all women around the world with a celebration by the inspiring and talented women of the Yale community. The evening will feature performances and presentations by student and spouse groups, snacks and refreshments, and flowers for all the women in attendance!
Venue: International Center Cafe, 421 Temple Street, Yale, New Haven
Organization: Yale: World famous University

Date:08 March 2009
Time:15:00 - 17:00
Event: Artists Reception
About: An art collection including recycled artwear, sculpture, paintings and photography from artists Anita Balkun, Maria Brower, Maureen Edwards, Heather Monaghan, Jill Nerkowski, Melissa Spencer, Cathy Valley, Jennifer Shafer Wood and Barbara Williams.
Venue: The Buttonwood Tree Performing Arts and Cultural Center, 605 Main Street, Middletown, CT, 06457
Organization: North End Arts Rising: A small nonprofit arts organization providing support, a performance and exhibit space, funding and opportunities for artists and students in the Middletown area.