Right to Health and Public Health – Page 10 – UAB Institute for Human Rights Blog

An Argument for Decriminalizing Sex Work

Abstract of a red light — Abstract at a Red Light. James Loesch. Creative Commons for Flickr.

Different human rights groups support or have called for the decriminalization of sex work. Some of which include Amnesty International, World Health Organization, UNAIDS, International Labour Organization, the Global Alliance Against Trafficking in Women, the Global Network of Sex Work Projects, the Global Commission on HIV and the Law, Human Rights Watch, the Open Society Foundations, and Anti-Slavery International.

Picking on one, the Human Rights Watch supports the full decriminalization of consensual adult sex work in support and defense of human rights relating to personal autonomy and privacy as, “A government should not be telling consenting adults whom they can have sexual relations with and on what terms.” Joining 61 other organizations, they recently advocated for a bill that would decriminalize sex work in Washington, DC. This Community Safety and Health Amendment Act intends to repeal statutes that criminalize adults who voluntarily and consensually engage in sexual exchange, while it upholds and defends the legislature which prohibits sex trafficking. The HRW affirms that adult consensual sexual activity may be covered by the concept of privacy, rejecting the idea that criminalization was a protective measure against HIV and STIs, and conveying that it was more likely to drive a vulnerable population underground.

However, the demands of these organizations and supporters of sex workers have surfaced controversy around sexuality, health, economics, and morality. Often the idea of sex work may be tied to or conflated with sex trafficking, child sex abuse, and rape. Open Society Foundation simply defines sex workers as “adults who receive money or goods in exchange for consensual sexual services or erotic performances, either regularly or occasionally.” Sex work encompasses a wide range of professions and activities which include the trade of some form of sexual activity, performance, or service for a client to a number of fans for some kind of payment (including prostitution, pornography, stripping, and other forms of commercial sex). It is clearly separated from those services that utilize “the threat or use of force, abduction, deception, or other forms of coercion for the purpose of exploitation”. Decriminalizing sex work would call for the “removal of criminal and administrative penalties that apply specifically to sex work, creating an enabling environment for sex workers’ health and safety.” Amnesty International expands on these definitions in this report.

Many members of society view sex work as immoral or degrading to women, arguing that sex work is inherently exploitative of women, even if these workers find it profitable or empowering- even simply as the power to creatively express one’s sexuality. When we think of sex workers, we tend to assume they were forced into it or assume a desperate narrative with no other options. Then, maybe, we judge their appearance while tying it to their worth or a fantasized idea of sex workers opposed to the ordinariness we associate with other professions and community members. A simple argument says that, like any profession, there are extremely different motivations to pursue these professions and, in the end, it’s a job or choice of work with its own pros and cons for each lifestyle (affording many lifestyles). Also, anyone and any personality can be a sex worker.

People enter and remain in this work for a multitude of reasons creating each individual experience of sex work; however, many face the same response and abuse in the workplace or trade. Owning to the stigma associated with the profession, not many can come out and say they are a sex worker. They must fight to be recognized beyond the stigma or continue to repress or hide their daily lives from their community or society. Sex workers report extreme violence and harassment from clients, managers, police and society and even more cannot report these violences, facing incrimination or even incarceration. Ironically, laws on sex work undermine governments’ own efforts to reduce high rates of violence against women and reduce rates of HIV infection in sex worker populations.

Repressive policing not only further marginalizes sex workers as a whole, but it also reinforces what it promises to remove as it exposes sex workers to different abuses and exploitation by police or law enforcement officials who may arrest, harass, physically or verbally abuse, extort bribes and sexual services, or deny protection to sex workers avoiding the eyes of the law. Some sex work may be illegal because it is viewed as immoral and degrading, but people governed by these laws do not share the same moral beliefs. As police fail to act on sex workers’ reports of crimes, or blame and arrest sex workers themselves, offenders may operate with impunity while sex workers are discouraged from reporting to the police in the future. Then there is the financial toll of criminalization as repeating fines or arrests push some further into poverty. People may be forced to keep selling sex as potential employers will not hire those with a criminal record. Also, if the need for money found some sex workers in the streets, how will fines deter the work?

The work entails forming relationships with a wide range of clients at different levels of intimacy. Unfortunately, sex work offers comfort to predators, or those who mean harm, who also understand and exploit the workers paralleling relationship with police. Working in isolation, workers’ lives are threatened as they avoid the police and are denied these protections in their workplace and, off the hook, predators continue to harm more even those outside of the sex trade. Facing arrest or prosecution themselves, any client may protect themselves from blocked numbers leaving workers in the dark with no evidence of whom they are dealing with, surrendering that safety. Some laws advocate helping sex workers by removing the option of work as it criminalizes only those who buy sex. Now, to incentivize clients and income, workers may be forced to drop prices, offer more risky services, or reach out to potentially abusive third-party management.

Woman holding poster reaing "Sex Workers Demand Safe Spaces" — Sex Workers Demand Safe Spaces. Fibonacci Blue. Creative Commons for Flckr.

Decriminalizing and regulating the work of sex workers would allow them the right to choose their clients and negotiating power or power to cease the service when they feel uncomfortable or unsafe. Criminalization, or the threat of it, complicates and weakens workers’ power to negotiate terms with their clients or collaborate with others for safety. So, for example, it may increase the chance for workers to engage in sex with clients without a condom (which may be used as evidence of the crime). Although variable in different contexts, in low and middle-income countries on average, sex workers are 13 times more at risk of HIV, compared to women of reproductive age (age 15 to 49), so their ability to negotiate condom use is important.

According to a study led by the London School of Hygiene & Tropical Medicine and published by the American Association for the Advancement of Science, sex workers who had been exposed to repressive policing had a three times higher chance of experiencing sexual or physical violence by anyone, including clients and partners. They were also twice as likely to have Sexual Transmitted Infections than those who avoided repressive policing.

In order to be protected from exploitation by third party managers and dangerous clients, to be informed on sexual transmitted infection and other health concerns or vulnerabilities, to be able to unionize and self-manage, and to be able to reach out to law enforcement, sex work should be regulated by the same occupational safety and health regulations that benefit workers in other labor industries. Dedicated efforts must consider the elevated or unique risks, vulnerabilities, and intersectional stigmas surrounding different sex workers, including men, transgender, and other gender identities and portions to improve health outcomes and human rights. Wider political actions are needed to address inequalities, stigma, and exclusion or marginalization that sex workers face even past the criminal justice system to health, housing, employment, education, domestic abuses, etc.

We are faced with opposing or contradictory narratives of the sex work experience, but we have chosen some to represent the entire concept especially those tailored to our own feelings of sex and commerce without concern or consideration of those even more immediately affected. The conversation of sex work needs to open up to understand and share the message to all that the labor itself is the commodity, not the laborer and it requires workers more considerate rights and regulations. If sex work is legally accepted with due rights and respect, it can become something that benefits- even especially vulnerable or marginalized- women and humanity.

“What sex workers need is not condescension and invasion into their private lives, but support in achieving decent working conditions.”

Additional Sources:

Open Society Foundations

Vox

Family Fire: A Gun Safety Issue

A child holding a gun — Source: Yahoo Images, Creative Commons

Last week, a 2-year old boy accidentally shot himself in his home in southwest Birmingham. Fortunately, he survived the gunshot wound and is being treated at the Children’s of Alabama hospital. The police are not sure how he obtained the gun yet, but the investigation is ongoing. Last month, a case of a two-year old boy in Indiana was reported who lost his life after finding his mother’s unsecured gun in their home and accidentally shot himself. A few months ago, a 12-year boy in Mississippi accidentally shot and killed his sister of the same age while playing with a gun. There are numerous other cases like these when children get access to unsecured firearms and end up in such horrific circumstances. These accidental shootings are defined by the term “family fire.”

Family fire is a shooting that involves improperly stored or misused gun(s) found in the home, resulting in injury or death, including unintentional shooting, suicide, and other gun-related tragedies. Family fire is a constant threat for all members of the household where firearms are not properly stored. The Harvard Injury Control Research Center found that the prevalence of guns AND unsafe storage practices are associated with higher rates of unintentional firearm deaths. It was also found that youth killed in these gun accidents are shot by other youth in most cases, usually someone of their own age and typically a family member or friend.

Every day, family fire injures or kills eight children in America. According to a report from the New York Academy of Medicine, children under the age of 18 suffer the most from in-home gun-related incidents. For suicides and unintentional deaths, the gun used almost always comes from the child’s home, resulting directly from improperly stored firearms and the lack of proper precautions. Over 4.6 million children in the United States live with unlocked or loaded guns in their homes.

A large body of evidence has shown that the presence of guns in a child’s home substantially increases the risk of suicide and unintentional firearm death, though recent data suggests that not a lot of gun owners appreciate this risk. Parents and other adults who own guns tend to greatly underestimate the possibility of children being able to access those arms. It has been found that 75 percent of kids know where that gun is stored in their home. A report on “Parental Misperceptions About Children and Firearms” revealed another shocking fact that one in five kids had handled a gun in the absence of their parents. Not only that, children’s exposure to unsafely stored firearms can also have consequences beyond the home. It has been found that 75 percent of school shootings are facilitated by kids having access to unsecured and/or unsupervised guns at home.

Considering the seriousness of these statistics and the deadly consequences of unsafe access to guns, Brady launched a “End Family Fire” campaign. Through this initiative, they strive to promote the use of the term “family fire” in order to raise awareness of this nationwide crisis and drive social change by educating and encouraging gun owners about safe gun storage. Their belief is that family fire can be ended with joint community action and public awareness and that lives can be saved through promoting safe storage practices.

Ad Council, America’s leading producer of public service communications, partnered with EndFamilyFire.org to bring attention to this pressing issue and to encourage people to learn more about proper gun safety and responsible ownership.

Research data from the New York Academy of Medicine shows that:

“The risk of unintentional and self-inflicted firearm injury is lower in homes that store firearms unloaded (compared with loaded) and locked (compared with unlocked). In keeping with this evidence, guidelines intended to reduce firearm injury to children, first issued by the American Academy of Pediatrics (AAP) in 1992, assert that whereas the safest home for a child is one without firearms, risk can be reduced substantially, although not eliminated, by storing all household firearms locked, unloaded, and separate from ammunition.”

There is a lot of conversation around gun violence and gun rights in America. Much of this debate is focused on the 2^nd Amendment of the US Constitution, which states that “A well-regulated Militia, being necessary to the security of a free State, the right of the people to keep and bear Arms, shall not be infringed.” Yet, what we need to understand is that this is more than a conversation about gun rights, gun violence, and whether or not people should have the right to bear arms. I’m sure that we can all agree on the importance of preventing our kids from the risks and deadly consequences of having easy access to firearms. Those on all sides of the Second Amendment debate and gun owners and non-gun owners need to come together to promote safe practices and prevent unfortunate incidents like family fire from occurring.

The first and foremost step is to safely store the firearm(s). It has been found that keeping guns locked and unloaded reduces the risk of family fire by 73%. Additionally, storing ammunition separately from its gun reduces the risk of family fire up to 61%. Keep them out of the reach of others, especially children, who can use them to dangerous outcomes. The State of New Jersey has required sellers to provide trigger locks or locked gun cases with each gun purchase, among other laws this has contributed in a decline of unintentional gun death cases in the state. It is another way to promote safe gun storage and making sure that people have the necessary equipment to do so.

Another way is to encourage discussions around responsible gun ownership and safe storage practices within our social circle, family, friends, and colleagues. The most important thing to do is to have a conversation with your kids. Make sure that they understand their limits on accessing firearms, do not consider it a toy, and understand the severity of consequences that may arise as a result. Discussing gun safety and making it a part of the family’s safety conversation is important, especially for gun owners because they play a powerful role in educating others about safe storage practices. Additionally, we need to begin asking others about the presence of unsecured guns in the home for their own safety, before moving in with someone, and before sending your kids to anybody’s home.

Family fire is a pressing issue affecting many families everyday in the country. We as a society need to take up the responsibility of addressing this problem, encouraging the lawmakers and security agencies to take notice and action, and play our part by both promoting and practicing safe gun storage practices.

The Criminalization of Mental Illness

Prison cell block. Source: Bob Jagendorf, Creative Commons.

It is no secret that the United States has an issue of overcrowding prisons, which can lead to many issues regarding quality of life in prisons. Overcrowding in prisons is not just a problem in the United States; over 100 other countries also have this issue. In many countries, the criminalization of mental health is a factor that is compounding the issue. Individuals with severe mental illnesses not only need treatment that prisons don’t provide, but also can be put in dangerous situations when they are in prison. Despite this, they are more likely to end up in prison than in treatment.

Up until the 1960s in the United States, when someone had a severe mental illness, they were typically placed in a mental institution or asylum. In an effort to provide patients in mental institutions better community-based care and reduce government spending, the process of deinstitutionalization began. However, that is not how it played out. While the movement gave those with mental illness more rights and turned society away from locking them up, it released some that would have benefitted from long-term care that community centers could not provide. However, with many patients moving out of long-term treatment facilities, many of these facilities were shutting down. This left community mental health centers to try to treat illnesses they were not originally intended to. Another issue arose when insufficient funding was allocated for the community mental health centers, further overwhelming the new system. Because the difficulty of the transition from institutionalization to community care was underestimated, many—then and today—have gone without treatment. The lack of treatment for serious mental illness, like Schizophrenia, has led to the incarceration of many people with mental illness who should instead be treated.

Not Guilty by Reason of Insanity

Another issue that has contributed to the criminalization of mental illness is the difference between the clinical definition of mental illness and the legal definition. The diagnosis of mental illness is dictated by the Diagnostic and Statistical Manual of Mental Disorders (DSM). The law, however, sees mental illness as symptoms that impair mental functioning. The main diagnoses that fits into the legal definition are psychotic disorders, such as Schizophrenia. Even if someone has been diagnosed with a psychotic disorder, when pleading not guilty by reasoning of insanity, their lawyer must show that they were having symptoms at the time of the crime that contributed to said crime. This can be a difficult task as some states require that the symptoms are so severe that the defendant didn’t know that the crime was illegal. Even in cases where the defendant has shown this to be true, some juries will give a verdict of guilty to ensure that someone is held accountable for the offense.

Some states have gotten rid of the insanity plea altogether, while others have changed it to “guilty because of mental illness” meaning after treatment, they must serve their sentence in prison. This can sometimes put the progress a patient has made in jeopardy, as prisons are not a suitable environment for maintaining a newly achieved healthy mental state. In states where not guilty by reason of insanity is still in effect, those found not guilty by reason of insanity are supposed to be released after sanity has been restored. Yet, this is rarely the case; due to fear they will go off their medicine and commit the same violent crimes, many are held in treatment facilities indefinitely. With the threat of this outcome overhead, many opt out of the not guilty by reason of insanity plea and are instead place into a prison where they will not receive the appropriate care.

Because of the law’s strict definition of mental illness, many are being placed in already crowded, underfunded prisons. Because of the lack of mental health professionals, prisoners in some states, including Nebraska, may not receive medications for mental illnesses or have access to talk to counselors. This can cause the reemergence of once-controlled symptoms, making the prisoner with a mental illness a danger not only to himself, but also to others. Additionally, many with severe mental illness are put in solitary confinement for long periods of time. Psychologists who have studied the effects of solitary confinement have seen a pattern of increased mental health problems in people who were originally neurotypical. If this is true, the effects on prisoners with mental illness could be devastating. Not only are people being sent to prison when they should receive treatment, they are also being put in situations that make their symptoms worse and make it harder to reenter into society if their sentence allows.

Substance Use Criminalization

In addition to violent crimes committed because of mental illness, many nonviolent acts associated with mental illness are criminalized; Substance Use Disorders are recognized by the DSM V and are therefore diagnosable and treatable, but the law instead criminalizes it. While at any given time there are more convictions for violent crimes, more people are sent to prison a year for drug-related crimes than violent crimes. Studies have shown that those imprisoned for drug-use are unlikely to receive treatment and often return to using drugs once released because they lack the resources that treatment would have given them. Sending people with Substance Abuse Disorders to jail does not improve their illness.

Not only those with Substance abuse disorder are affected by this criminalization; those diagnosed with another mental illness are five to eighteen times more likely to have a comorbid Substance Use Disorder. This can further prevent someone who needs treatment from receiving it. Most prisons don’t have adequate resources to treat prisoners with mental illness, so imprisoning people for crimes that are directly tied to mental illness can be detrimental to their treatment and future.

Current solutions

Some states are trying to combat the increasing proportion of prisoners with mental illness not receiving treatment. With our corrections system slowly catching up with our understanding of mental illness, states—like California—are beginning to consider replacing their old jails, not with new ones exactly like them, but instead with centers focused on rehabilitation. They are not calling for moving all criminals with mental illness out of prisons, but instead treating those with mental illness while they serve their sentence. Additionally, they do want to increase the diversion from jails, but that will be done on a case-by-case basis and only for those who have committed a crime because of mental illness.

Stigma

Ultimately, the criminalization of mental illness has a lot to do with the stigma surrounding it. The general population connects mental illness with violence, which leads to harsher punishments. As a society, we need to reduce stigma before any change can happen. If we continue to see those with mental health problems as inherently violent, they will continue to be prosecuted and sentenced unjustly.

Examining Period Poverty

A worker trims and stacks sanitary pads before they are lined and sewn at the Afripads factory. — **A worker trims and stacks sanitary pads, Source: Yahoo Images.**

Period poverty is the lack of access to sanitary products, menstrual hygiene education, toilets, handwashing facilities, and or waste management. The term also refers to the increased economic vulnerability that women and girls face due to the financial burden posed by menstrual supplies. In least-developed and low-income countries, access to hygienic products such as pads, tampons, or cups is limited. This means that girls will often resort to using proxy materials such as mud, leaves, or animal skins to try to absorb the menstrual flow. As a result, such women are at a higher risk of developing certain urogenital infections, like yeast infections, vaginosis, or urinary tract infections. This becomes an issue because while the majority of women are of reproductive age, the majority of these women and girls are unable to practice proper hygiene practices. Consequently, women and girls around the world, especially in developing countries, face numerous challenges in managing their menstruation. Furthermore, some/many women are forced to approach this normal bodily function with silence due to stigma, as some communities consider menstruation to be taboo.

What causes period poverty?

One cause is that pads and other supplies may be unavailable or unaffordable. This means that women are often forced to choose between purchasing sanitary pads and different basic needs, or they may live in areas where there is no access to hygiene products at all. More importantly, young girls may lack access to toilet facilities with clean water to clean themselves while on their periods. In addition, discriminatory cultural norms make it challenging to maintain good menstrual hygiene as women often have to hide, or the community may not put enough effort into establishing hygiene facilities or practices around them. Also, some women and girls lack the necessary education and information about menstruation and good hygiene practices because topics around menstruation and proper hygiene practices are rarely discussed in families or schools.

What is more, other girls may experience menstruation with little or no knowledge of what is happening. This makes it harder for women to adopt sanitary practices because most remain unaware of recommended hygiene practices. In many communities, menstruating girls and women are still banned from kitchens, crop fields, or places of worship. There is also the issue of forced secrecy in communities where girls are exposed to ‘menstrual etiquette.’ This etiquette encourages the careful management of blood flow and discomfort and the importance of keeping menstruation hidden from boys and men.

A Human Rights Issue.

It is important to consider gender inequality, extreme poverty, and harmful traditions as the source of menstrual hygiene deprivation and stigma. This often leads to exclusion from public life, heightened vulnerability, and creates barriers to opportunities such as employment, sanitation, and health.

Some of the human rights that are undermined by period poverty include,

The right to human dignity– When women and girls cannot access safe bathing facilities and safe and effective means of managing their menstrual hygiene, they are not able to manage their menstruation with dignity. Menstruation-related teasing, exclusion, and shame also undermine the right to human dignity.
The right to an adequate standard of health and well-being– Women and girls may experience negative health consequences when they lack the supplies and facilities to manage their menstrual health. Menstruation stigma can also prevent women and girls from seeking treatment for menstruation-related disorders or pain, adversely affecting their health and well-being.
The right to education – Lack of a safe place or ability to manage menstrual hygiene as well as lack of medication to treat menstruation-related pain can all contribute to higher rates of school absenteeism and poor educational outcomes. Some studies have confirmed that when girls are unable to manage menstruation in school properly, their academics and performance suffer.
The right to work – Poor access to safe means of managing menstrual hygiene and lack of medication to treat menstruation-related disorders or pain also limit job opportunities for women and girls. They may refrain from taking specific jobs, or they may be forced to forgo working hours and wages. Menstruation-related needs, such as bathroom breaks, may be penalized, leading to unequal working conditions. And women and girls may face workplace discrimination related to menstruation taboos.
The right to non-discrimination and gender equality – Stigmas and norms related to menstruation can reinforce discriminatory practices. Menstruation-related barriers to school, work, health services, and public activities also perpetuate gender inequalities.

What is being done?

In spite of the issues presented, it is essential to acknowledge that a lot is being done around the world to help eradicate period poverty.

For example, UNFPA (United Nations Population Fund), has various approaches to promoting and improving menstrual health around the world. Some of them include,

UNFPA reaches women and girls directly with menstrual supplies and safe sanitation facilities. In humanitarian emergencies, UNFPA distributes dignity kits, which contain disposable and reusable menstrual pads, underwear, soap, and related items. (In 2017, 484,000 dignity kits were distributed in 18 countries.)
The UN organization also promotes menstrual health information and skills building. For example, some UNFPA programs teach girls to make reusable sanitary napkins. Others raise awareness about menstrual cups.
Furthermore, the organization aims to improve education and information about menstruation as human rights concerns. This is done through its youth programs and comprehensive sexuality education efforts, such as the Y-Peer program.
UNFPA also procures reproductive health commodities that can be useful for treating menstruation-related disorders. For instance, hormonal contraceptive methods can be used to treat symptoms of endometriosis and reduce excessive menstrual bleeding.
Similarly, UNFPA is helping to gather data and evidence about menstrual health and its connection to global development. For instance, UNFPA supported surveys provide critical insight into girls’ and women’s knowledge about their menstrual cycles, health, and access to sanitation facilities. A recent UNFPA publication offers a critical overview of the menstrual health needs of women and girls in the Eastern and Southern Africa region.

Further Recommendations

While there exists a lot of support to help end period poverty, there is still a lot that can be done to improve access to sanitary products, menstrual hygiene education, toilets, handwashing facilities, and, or waste management. Human Rights Watch and WASH United recommend that groups which provide services to women, evaluate their programs to determine whether a woman or girl has,

Adequate, acceptable, and affordable menstrual management materials;
Access to appropriate facilities, sanitation, infrastructure, and supplies to enable women and girls to change and dispose of menstrual materials; and
Knowledge of the process of menstruation and options available for menstrual hygiene management.

Practitioners engaged in programming or advocacy related to menstrual management should also,

Have an awareness of stigma and harmful practices related to menstruation in the specific cultural context where they are working.
Support efforts to change harmful cultural norms and practices that stigmatize menstruation and menstruating women and girls;
Address discrimination that affects the ability to deal with menstruation, including for women and girls with disabilities
Be aware of and incorporate human rights principles in their programming and advocacy, including the right to participate in decision-making and to get information.

Moreover, women and girls must have access to water and sanitation. This will allow the establishment of private areas to change sanitary cloths or pads, clean water for washing their hands and used fabrics, and facilities for safely disposing of used materials or drying them if reusable. It is also imperative that both men and women have a greater awareness of menstrual hygiene. This means that training and learning courses should be made available for women and young to teach them the importance of menstrual hygiene and the proper practices. Likewise, educating boys on the challenges and struggles girls face could help reduce stigma and help them become more understanding and supportive husbands and fathers. Less work has been done in this area, but the benefits of educating boys about adolescence for both themselves and female students are increasingly being recognized.

It is essential to acknowledge that there is still limited evidence to understand women’s use of sanitation and menstrual management facilities. Therefore, there is a need for individuals to pay special attention to the needs of women and girls all over the world.

Healthcare Disparities for Rural Communities

Hospital closed sign directing patients to the next nearest hospital — Hospital Closed. Source: Nigel Goodman, Creative Commons

Access to healthcare is one of the biggest predictors of health. When someone has access to healthcare, they are more likely to seek treatment for and catch chronic diseases in early stages. This can greatly improve health outcomes and quality of life. However, when access to healthcare is restricted in any way, health outcomes and quality of life decrease, those who need consistent treatment may go without, and preventable deaths increase. Rural areas disproportionately face decreased access to healthcare, which greatly affects the health and productivity of these already disadvantaged areas.

Lack of Insurance

There are many barriers to healthcare that rural Americans face. First of all, there is a lack of insurance. This is mainly because insurance premiums are more expensive in rural areas than they are in urban areas. Urban areas have larger populations, which encourages more insurance companies to compete with each other, driving the costs of premiums down. Additionally, their larger population means the cost of medical expenses can be spread among more people. This also lowers premium prices. Because these two factors are not present in rural areas, they are left without affordable healthcare.

Additionally, many people in rural areas have incomes that fall in th e gap between qualifying for Medicare and being able to afford private insurance. Medicare is available to specific low-income groups. In states that haven’t expanded Medicaid, the most common income limit for Medicaid eligibility is 43 percent of the Federal Poverty Line and childless adults are excluded regardless of income. These qualifications leave over 2 million adults in the United States uninsured. Insurance is important because it can help cover costs of healthcare which can otherwise become insurmountable. Those without insurance are less likely to seek healthcare, and when they do, it is typically worse quality than those with insurance receive. Additionally, when an uninsured individual does seek healthcare, the costs are sometimes too high and turn into medical debt. Since much of the rural population is uninsured, these problems plague many of them.

Closing Hospitals and Pharmacies

Those that do have insurance still face a bigger problem: many rural areas don’t have hospitals within a twenty-minute drive. 25 percent of those living in rural areas report that they have to drive at least 30 minutes to get to the nearest hospital. In fact, almost one in four rural Americans say access to adequate healthcare is a major issue for them. Additionally, many hospitals in rural areas are shutting down, leaving communities without the healthcare they are used to. Since 2010, there have been over eighty rural hospital closures, mainly in the southeast. These hospital closings have a devastating effect on the communities they were a part of. Mortality rates for accidents, heart attacks, strokes, and anaphylactic shock risedue to longer ambulance rides. Additionally, residents may be unable to attend routine appointments because of transportation limitations; much of the rural population is elderly, which restricts their ability to drive, and public transportation is less common in rural areas than urban areas. This also means that with the onset of troubling symptoms, residents of rural areas may wait longer to see a doctor because of the inconvenience.

Many rural areas also lack pharmacies, which can hurt those who rely on prescription drugs for good health. Even the rural communities that have hospitals may lack a pharmacist, and many of the pharmacies in rural areas are in danger of closing; many have already. This is due to higher costs of medications at rural pharmacies and lack of pharmacists in rural areas. This can have a devastating effect on residents, as many go periods of time without their prescriptions—like Insulin or medication for depression— until they can get to the nearest pharmacy. Additionally, pharmacists in rural areas are helpful in educating the community on when they can use over-the-counter meds and when patients should see a doctor.

But why are hospitals and pharmacies closing? They have few patients, many uninsured, and they are greatly affected by states’ refusal to expand Medicaid. Medicaid expansion, which 14 states have not ratified, would close the gap between those that qualify for Medicaid and those that can pay for private insurance. As discussed previously, those with insurance are more likely to seek medical care, which would bring more business—and therefore, funding—to hospitals and pharmacies, making them less likely to close. Additionally, they lack the staff required to stay open. 99 percent of students in their last year of medical school report they plan to live in communities with over 10,000 residents. Without a staff, a hospital cannot stay open.

Lack of Specialists

In many rural areas, including those with hospitals, there’s a lack of specialists, like oncologists and OB/GYNs among others. Specialists typically work in large hospitals that have adequate resources, so they tend to reside in cities. This means that those with specialized needs often have to drive to the nearest city to receive care. Traveling can pose a problem to many rural Americans as many of them are older, but this also affects many younger rural inhabitants as they may not have the time off from their jobs to drive hours to receive specialized care. This leaves many without treatment that they need and worsens health outcomes. This is especially concerning considering many rural communities have higher rates of diseases than urban communities do. Specifically, “rural African Americans have higher rates of cancer morbidity and mortality than other rural residents and have higher rates of comorbid conditions” according to Robin Warshaw from the Association of American Medical Colleges. Rural African Americans also have higher rates of disease than urban African Americans. This makes the fact that specialists are not easy to access even more concerning, especially considering they are the largest rural minority. Minorities in general have less access to healthcare, and living in an area that doesn’t have easy access to healthcare in general can exacerbate this issue.

Low Health Literacy

The healthcare system is complex, which means that patients have to work to understand what care they need and when they need it. The ability to do so is called health literacy. Studies have shown that health literacy is important to health outcomes. The higher level of health literacy a person has, the more likely they are to seek out preventative care, such as screening tests and immunizations, that can catch diseases in early stages or prevent them altogether. If a patient doesn’t understand what the doctor tells them, they are less likely to be comfortable enough to seek care. Additionally, higher health literacy rates make it easier to understand how to manage existing conditions. In addition to less access to healthcare, rural Americans have lower health literacy, which compounds their health problems. However, because rural citizens are less likely to have access to health care, it is especially important for them to have high health literacy, which can be attained by using programs that work to educate patients and clinicians on the importance of patients having an active role in their healthcare.

Solutions

Rural healthcare in America is a big problem, but it can improve. In addition to the health literacy programs, there are many solutions to close the gap in healthcare between rural and urban areas. While the common medical school experience trains students for work in populated areas, a consortium of 32 medical schools has created a rural healthcare track with their medical schools. This not only puts more doctors in rural areas, but also trains them for rural areas’ specific health needs. While the program is too new to see a significant increase in rural healthcare professionals, the majority of students who have gone to residency have stayed in rural areas and are studying specialties that are in much needed in rural areas. Additionally, there are many scholarships for those planning on practicing medicine in rural areas, further encouraging medical students to practice in areas in need of doctors.

The Nutrition and Health Crisis in Venezuela

Child wears hat that says Venezuela on it and stares off into the distance. — ELEICOES 2013 NA VENEZUELA. Source: Joka Madruga, Creative Commons

The current president of Venezuela, Nicolás Maduro, was elected in 2013 by a very small margin. During his first term, the Venezuelan economy took a turn for the worst. He was reelected for a second term in 2018, but his opponents feel that the election wasn’t valid because many of the other candidates were made ineligible to run or even jailed, so the National Assembly does not recognize his presidency and considers the presidency vacant. According to the Venezuelan Constitution, in cases of a vacant presidency, the leader of the National Assembly (currently Juan Guaidó) takes over as president. Guaidó has very little political power because the military still supports Maduro.

I first heard about the political and economic unrest in Venezuela when I went on an exchange trip to Spain in May of 2016. My host family had moved to Spain eight months earlier because their jobs had been the first affected by the economic downturn. They were lucky that the dad was a Spanish citizen—it was much easier for them to move to Spain than if none of them had been citizens—but many Venezuelans have not been so lucky.

Protests in Venezuela — Venezuelan Protests. Source: Trong Khiem Nguyen, Creative Commons

Since 2015, health statistics have been underreported—if they’ve been reported at all. December of 2016 marked the last report from the Venezuelan Ministry of Health. This report describes an alarming increase in previously eliminated and controlled infectious diseases, such as malaria and diphtheria, and in maternal and infant mortality rates. The report has many alarming statistics, but aside from that, it is the last one to have been published. Additionally, the Health Minister who published the report was fired immediately afterward.

With no one within the country reporting on the health needs and statistics of the people, it is nearly impossible for other countries to give external aid. Additionally, even when aid sent, the Venezuelan government refuses help. Even nongovernmental organizations (NGOs) are forced by law to refuse help: the Supreme Court ruled in 2010 that any NGOs receiving financial assistance from other countries would be committing treason. This has a devastating impact on the citizens as they are not receiving the help that they need.

The situations in the hospitals are dismal. According to a survey conducted by the political opposition, many services in hospitals are not consistently available, if at all, due to lack of supplies. Many supplies have gone missing from public hospitals and clinics, and those being shipped in often are embargoed and never make it past the ports. The reason is unknown, but many suspect it has to do with the corruption of the government. This has forced patients to bring their own medical equipment—which can include anything from medicine to surgical equipment—when going to the hospital, so they know they’ll have what they need. Private clinics, which have most of the supplies they need, ask for payment in US dollars, which means only the wealthiest can get that level of care. This leaves the average citizen without proper medical care in a country where the government is actively keeping lifesaving materials out of the hands of doctors.

Because of the low levels of health care, many diseases are reemerging and worsening. Between 2008 and 2015, there were no cases of diphtheria reported and one case of measles reported. However, in the past three years, over one thousand cases of diphtheria and over six thousand cases of measles have been confirmed. These statistics show a lack of vaccinations in children, which is potentially due to limited vaccines available. Malaria rates, which were once controlled through pesticides, medication, and reduction of mosquito breeding areas, have increased by over ten times from 2009 to 2017. Tuberculosis cases more than doubled from 2014 to 2017, which is even more concerning with the cases of untreated HIV on the rise as well. According to the Human Rights Watch, “Venezuela is the only country in the world where large numbers of individuals living with HIV have been forced to discontinue their treatment as a result of the lack of availability of antiretroviral (ARV) medicines.” 90 percent of HIV positive Venezuelans have to live without ARV medicines, and these people are majorly susceptible to and will be severely affected by the many diseases that are on the rise. Because all of these diseases are on the rise and the limitations of hospitals, maternal and infant mortality rates in Venezuela have risen back to their levels from the 1990s. Venezuela is the only Latin American country where this has occurred.

In addition to the health crisis, there is also a nutrition crisis. The last nutrition data published was in 2007, but many Venezuelans report only eating yuca or a tin of sardines for their one meal of the day. According to the UN’s Food and Agriculture Organization (FAO), 11.7 percent of the population is undernourished, meaning they are not getting enough nutrients. This is severely affecting Venezuelan children; as of March 2018, 17 percent of children under 5 in lower income areas of Venezuela have moderate acute malnutrition (MAM) or severe acute malnutrition (SAM)—a 7 percent increase from February 2017 and a level of crisis. According to WHO, the fatality rates for children under the age of five who have SAM and MAM are between 30-50 percent, so it is important that children not only have access to healthy food, but that hospitals also have access to the necessary treatments, and at this time that is not generally the case in Venezuela. Pregnant women are also affected by MAM and SAM, which can lead to adverse outcomes during pregnancy, childbirth, and the child’s infancy.

Venezuela is not the only country that is experiencing a health and food crisis. However, many countries have these issues due to lack of resources, funding, or aid. While Venezuela is experiencing an economic downturn, they have been offered plenty of aid, which they have repeatedly refused. Additionally, the lack of reporting health and nutrition statistics is concerning for many reasons. First, this most likely means that no one, including the Venezuelan government, knows the extent to which the Venezuelan citizens are suffering. Second, it shows that the Venezuelan government is willing to conceal the level of suffering experienced by its citizens in order to protect their image, instead of asking for assistance; it sends a message that they do not care about the wellbeing of the citizens they are supposed to serve and protect. The UN continues to urge the Venezuelan government to let them send assistance, warning that their situation can become much worse than it already is, but they continue to refuse and push back on any assistance offered and put the lives of their citizens on the line.

The Sex Trafficking Industry Right In Alabama

by Dianna Bai

a picture of hands in chains — Source: Public Domain

You may have heard of the tragic situation straddling the I-20 corridor, the stretch of highway that runs between Birmingham and Atlanta.

Known as the “sex trafficking super highway,” the I-20 corridor is a hotbed for human trafficking.

The intimate settings of this illegal trade? Familiar places in our backyard: the hotels on Oxmoor Road, Woodlawn, Bessemer, and establishments all over the city of Birmingham.

Yet sex trafficking is not just confined to the I-20 corridor, as many media reports would suggest. It’s spread throughout the state of Alabama, in large cities and rural areas alike, appearing in myriad variations. The Global Slavery Index estimates that there are over 6000 victims of human trafficking each day in Alabama, which includes labor and sex trafficking.

As a $32 billion industry, human trafficking is the second-largest criminal industry in the world after the illicit drug trade—and it’s the fastest-growing. It’s the modern-day slave trade flourishing under the radar.

In the idyllic foothills of Alabama, we are touched by dark and complex operations with global reverberations.

Who are the victims of sex trafficking in Alabama?

Sex traffickers prey on the vulnerable, such as people who come from poverty or broken families.

According to The WellHouse, a non-profit organization that shelters young women in Alabama who have been victims of sex trafficking, there is a common “model” of a victim human traffickers prey on.

She is often a 12-14-year-old girl who has already been a victim of sexual abuse by a family member. An emotionally vulnerable young woman, she is lured in by the promises of comfort, love, and acceptance that an older man offers her.

He will later become her captor.

One example provided by Carolyn Potter, the executive director of The WellHouse, offers us a glimpse into the world of the girls who become victims of traffickers:

“There was a victim who had been abused by her stepfather—and her mother blamed her. Her captor started luring her in and buying her Hello Kitty items. She loved this. Nobody who was supposed to protect her protected her.”

Sex traffickers often prey on girls who have been abused by the people who love them. The accumulated trauma and experiences of abuse that these girls have been subjected to in their young lives gives rise to a sense of apathy and hopelessness.

So when their captors, who had been lavishing them with gifts and attention, start asking them to sell their bodies, their reaction is often, “Why not? This has been happening to me all my life.”

To numb the pain of repeated abuse, they may turn to drugs provided by the captors and become addicted. Traffickers then have a way to keep them from leaving.

A few might escape this life by her own efforts, but more often than not they escape through rescue operations carried out by law enforcement. In January of this year, the Well House participated in a sting operation led by the FBI during the Atlanta Super Bowl that rescued 18 girls and led to 169 arrests.

Once rescued, one of the most important steps to helping victims is simply the process of gaining their trust, as most victims who have been trapped in this life suffer from complex trauma. “Their level of PTSD is equal to someone who’s been in war,” Potter said.

What does the sex trafficking industry look like in Alabama?

As a criminal activity, sex trafficking in Alabama can take on many forms.

“Alabama is a microcosm of human trafficking around the world,” said Christian Lim, a professor of social work at the University of Alabama who is heading up a federally funded project on the subject. “There is just about every type of human trafficking in Alabama.”

On one end of the spectrum, there are individual pimps conducting a small-time business. They might even be family members who are pimping out their children for rent or drug money—and these cases often go unreported because of the family connection. On the other end, there are the massage parlors that are the fronts for international criminal networks, laundering money and trafficking women from places as far as China and Korea. These massage parlors routinely bring in $500,000-$800,000 a year, operating late into the night and advertising online at dozens of websites selling sex.

Sex trafficking has also risen in recent years among street gangs in Alabama with ties to Georgia, Florida, and even the West Coast, according to Teresa Collier at the Alabama Law Enforcement Agency. Street gangs such as the Bloods, Simon City Royals, Latin Kings, and Surenos are known to be engaging in sex trafficking to make a profit alongside the illegal drug trade. Recruiting mostly young victims, traffickers use “bottom girls” – prostitutes who are trusted by the pimps – to identify and recruit new girls, as well as a bevy of popular social media sites including Facebook, Twitter, Instagram, Snapchat, KIK, Meet Me, Badoo, and Seeking Arrangement. Gangs like the Surenos, which have a powerful reach back to El Salvador, can even coerce the women by threatening their families back home.

In many cases, other criminal activities such as drug dealing, money laundering, and murder also surround sex trafficking operations.

What’s being done about sex trafficking in Alabama?

One reason Alabama attracts traffickers of all stripes is because it is easier to get away with the crime than other states like Georgia that have a tactical task force dedicated to combating sex trafficking, according to Collier at the Alabama Law Enforcement Agency.

Also playing to the trafficker’s advantage is the fact that Alabama is mostly a rural state with greater distances between police stations and fewer resources for law enforcement, said Lim, the professor of social work at the University of Alabama. He also said there’s needs to be more awareness raised about this issue as many misconceptions exist about sex trafficking due to the popular media’s portrayal of sex trafficking in movies like “Taken.”

The Department of Homeland Security is investigating an array of cases in Alabama and prosecuting cases at both the state and federal level. “We have made human trafficking arrests at every socioeconomic level in Birmingham, from Mountain Brook to $35-a-night hotel rooms,” said Doug Gilmer, the agent in charge of the Department of Homeland Security’s Birmingham office. “Trafficking victims also run the spectrum, with girls ranging from age 12 to the 50s.”

DHS has also provided training to 1500 Alabama law enforcement officers to combat sex trafficking in the state and offers education to any community group that’s interested. These trainings focus on how to how to recognize the signs of sex trafficking, how to respond to a call, and how to support the victims.

Meanwhile, local law enforcement agencies such as the Tuscaloosa Police have jumpstarted special initiatives to combat sex trafficking in Alabama. The Tuscaloosa Police worked with Illinois’ Cooke County police three years ago in a “National Day of Johns” sting, specifically targeting the “demand” side of the industry. Officers placed fictitious ads for sex services on various sites, which led to the arrest of 135 Johns over 16 days.

But it’s a cat-and-mouse game as traffickers find new ways to advertise sex services, moving from online ads to alternatives like secret Facebook groups. Undercover agents are seeking out these secret online groups to find traffickers and victims as traffickers learn from past mistakes and become savvier at using the digital tools at their disposal. A popular website hosted in the United States, backpage.com, was shut down by the FBI several years ago, yet has created new challenges for law enforcement as dozens of newer and smaller sites have now popped up hosted by foreign servers that are outside the jurisdiction of U.S. law enforcement agencies.

Alabama’s state legislature is also moving on this issue. They have recently passed three resolutions that would require training for truckers and healthcare workers to spot the signs of human trafficking and make it easier for the trucker to identify victims. Two other bills moving through the legislature are intended to fine and “shame” johns for soliciting sex services.

“There should be no politics when it comes to protecting our children,” State Representative Merika Coleman told AL.com.

Right in Our Backyard

It is revealing and disheartening to see the extent of the modern-day slave trade right here in our backyard in Alabama. Without the right consciousness, it may be invisible to the average person. You may see a scantily dressed young woman walking through a gas station, a Sonic, or a Walmart. She is always accompanied by someone. She looks depressed or hopeless… You may have just run into a victim of human trafficking.

Vulnerable women (and men) and children are being exploited over and over again for the profit of more powerful and unscrupulous individuals and criminal organizations. The traffickers could be anyone, but what they have in common is a disturbing disregard for human life and human dignity. In Alabama, there are many dedicated agencies fighting for the human rights of these victims, including The WellHouse, Alabama Human Trafficking Task Force, Alabama Fusion Center, and the Department of Homeland Security.

For DHS agent Doug Gilmer, there is a sense of urgency to his mission because it is a crime that’s “unspeakable.”

“When you get into the nitty-gritty of sex trafficking at the street level and you are interacting with the victims, seeing what they go through, seeing what the traffickers do…. It’s horrible,” Gilmer said. “Seeing a 14-year-old girl with eight different STDs and the 35-year-old man who purchases this girl for sex?”

“It shocks the conscience.”

Important Links

The WellHouse – A 24-hour shelter offering immediate assistance to trafficked women who are rescued from anywhere in the United States.

EnditAlabama.org – A project of the Alabama Human Trafficking Task Force, which brings together public and private agencies to address the issue in Alabama.

Alabama Fusion Center – An information-sharing organization within the Alabama Law Enforcement Agency designed to combine or “fuse” information between federal, state and local government, private sector entities, and the intelligence community

Department of Homeland Security “Blue Campaign” – A national public awareness campaign, designed to educate the public, law enforcement and other industry partners to recognize the indicators of human trafficking, and how to appropriately respond to possible cases

Dianna Bai is a Birmingham-based writer who currently writes for AL.com. Her writing has been featured on Forbes, TechCrunch, and Medium. You can find her portfolio here.

Disability and Isolation in Our Modern World

by Marie Miguel

a picture of a young boy sitting alone on a park bench — Source: Public Domain

There are many types of disabilities. There is no one way to be disabled. One thing is for sure, living with a disability can be challenging. The navigation of places that are not disability-friendly remains overlooked. Having a physical disability means there is a need to make sure areas and spaces are accessible, and if you have an invisible disability, like severe anxiety, there is a need to ensure that you are mentally and physically prepared against possible triggering. However, there are no guarantees.

Misunderstanding and disabilities

Having a disability isn’t easy in this world. You want others to understand you, but it’s exhausting to try to keep re-explaining your experience. Some days you want to live a regular life, and not think about how you are different from others. If you are living with a mental illness, you are often misunderstood. People do not understand what it is like to live with severe anxiety, mania, crippling depression, or PTSD. Having to fight a constant battle with your mind is extremely difficult to explain to someone who does not know or care what it is like. For example, the thought of leaving the house is terrifying for someone with agoraphobia or similar phobias, while many others have no thoughts about it.

The world is not accessible as it should be; in fact, it is quite the opposite. It is difficult to mask or pretend to be “normal.” According to NAMI, one in five people have a mental illness. Mental illnesses are considered disabilities. If your mental illness is severe enough to impact your functioning, you might isolate and fear to be around others because you’re stigmatized. It is not healthy for the human experience, as social isolation may cause loneliness, depression, physical health complications, and may lead to taking one’s life.

As a society, what can we do?

We must work to understand those living with mental illness as well as other disabilities. There is a lack of understanding of differences when it comes to our society. We expect people to be cookie cutters and the standard of “normal” does not accurately reflect our world in terms of the human experience. The human condition is that we are all unique. The ADA limited in its protections against discrimination due to the stigma surrounding the identification of disability. The “yes, I have a disability” box on applications is supposed to allow for accommodations. Yet, the fear of stigma often paralyzes many people from checking it; checking the box places you in a proverbial box. The impact of being “boxed” because of a disability can have a severe impact on a person’s state of mind and overall wellbeing. Additionally, the failure to comprehend and/or empathize with persons with disabilities can come off as judgemental and further exasperate the issues.

Preventing social isolation

It is tempting to want to isolate when you cannot seem to find a sense of community or belonging, but we, as a society, can prevent this from happening. Studies show that isolation is as harmful to our health as smoking fifteen cigarettes per day. It is important to remember that an answer is available. One of the things that we can do in addition to raising awareness for disabilities and the experiences of people living with disabilities is to pursue mental health treatment. If you have a disability, no matter what it is, talking about how society impacts you is empowering. Whether you work with a counselor in your local area or try online therapy, you deserve to be heard. Speak out and up, advocate for yourself and others with disabilities, and take care of your mental health because you deserve it.

Marie Miguel has been a writing and research expert for nearly a decade, covering a variety of health-related topics. Currently, she is contributing to the expansion and growth of a free online mental health resource with BetterHelp.com. With an interest and dedication to addressing stigmas associated with mental health, she continues to specifically target subjects related to anxiety and depression.

Postpartum Depression Needs Serious Attention

by Marie Miguel

Maternity leave is necessary because it helps with postpartum depression

In the United States, maternity leave is almost non-existent. New parents in the U.S. get an average of three months of maternity leave, and some only get the twelve unpaid weeks of leave that employers are now required to offer under the Family Medical Leave Act. https://www.dol.gov/general/topic/benefits-leave/fmla Depending on where you work and how long you’ve worked for a company, you may not receive any paid maternity leave at all, which can cause a high level of stress for low-income parents and families. According to a study at the University of Maryland, longer maternity leave decreases the risk of postpartum depression. It’s suggested that this is because women can spend more time with their infants, and this is not surprising; if you don’t have the bonding time with your child that you need, it’s going to be depressing for you. You feel like you have to leave your child preemptively, and that’s not fair. Healthcare providers and policymakers need to think about how we can foster a more positive experience with maternity leave and help women get the care that they need. It’s essential that we think about maternity leave as being a preventative measure for postpartum depression.

Postpartum depression is serious

Postpartum depression is a severe mental health condition. Many women go undiagnosed with this mental illness because they unknowingly downplay their emotions to their mental health providers or general practitioners. Postpartum depression is a severe condition, and it needs immediate attention from a medical provider. It’s normal to be emotional after having a baby. But, there’s a difference between feeling down and having PPD. When you have a baby, it’s a huge life transition. You’re now responsible for taking care of a new life. Many moms have a difficult time with this change, and if you’re feeling overwhelmed, sad, or a variety of emotions after giving birth, that’s understandable. It’s when your feelings feel out of control that you need to worry whether or not you have Postpartum Depression. We’ll go over the symptoms of the condition, and you’ll see if you relate to them.

Postpartum Depression is not the baby blues

Postpartum depression is not just “the baby blues,” which affects up to 80% of new mothers. Postpartum depression affects childbearing individuals more severely. When you have PPD, it makes it nearly impossible to function. You feel severely depressed, hopeless, and scared. When a baby is born, you can have extremely intense emotions as a mother, which are frequently caused by changes in your hormone levels. Hormones make your experiences feel more powerful than they would ordinarily. You may be prone to crying or insomnia that occurs even after your baby is asleep, for example. Symptoms that can be considered part of the “baby blues” include mood swings, irritability, anxiety, and trouble sleeping. Postpartum depression, on the other hand, is a diagnosable disorder that exists as a potential side effect of giving birth. Unlike the baby blues, which is categorized by minor dips in mood, postpartum depression can be severely debilitating. Postpartum depression requires treatment, so if you have this condition or think that you might have it, don’t ignore it.

Symptoms of postpartum depression

The symptoms of Postpartum depression leave a mother feeling like she can’t cope with everyday life. You may be wondering what they are. The signs and symptoms of postpartum depression include severe mood swings, depression or depressed mood, feeling overwhelmed, not being able to sleep, feeling hopeless, fearing that you aren’t a good mother, restlessness, severe anxiety, inability to focus or think clearly, feeling worthless, thoughts of death or suicide, and intrusive, disturbing thoughts of harming yourself or your baby.

Postpartum psychosis is another condition to look out for and seek treatment if you think you have it. With postpartum psychosis, you may experience excessive thoughts about the baby, hallucinations or delusions, excessive energy or agitation, paranoia, and self-harm. If you believe that yourself or a loved one is experiencing postpartum psychosis, it’s vital that you seek treatment immediately.

What can we do as a society?

We need to take a stand as a society to help new mothers, and if we can prevent Postpartum depression, One of the things that we can do to help new mothers is to advocate for longer maternity leaves. Allowing new mothers to spend more time with their babies can prevent postpartum depression. In a society that’s so focused on productivity and getting back to work, one of the most important things that we can do to prevent postpartum depression is to push for employees to offer additional time for maternity leave. We want to spend time with our children; that’s only natural. If we’re not able to do that, of course, we’re more likely to experience postpartum depression, but it’s important to note that no new parent is immune to developing it. It’s nothing to be ashamed of, and it’s not your fault. Certain risk factors, such as family history or personal history of mood disorders, financial problems, unwanted pregnancy, and more, can increase a person’s likelihood of developing postpartum depression.

Getting help for postpartum depression

If you feel that you may have postpartum depression or if you’ve been experiencing symptoms of postpartum depression for over two weeks, it’s essential to schedule an appointment to talk to your doctor. Treatment for postpartum depression most often includes medication, if you need it, and most importantly, therapy. You can choose to see a traditional therapist or work with online therapy. New mothers can have the added challenge of trying to get out of the house, making it hard to get mental health treatment. Online therapy provides a forum to get therapy in the privacy of your home. A new mother may not have the energy to get out of the house to go to therapy. Online therapy can be an excellent resource for new mothers to get mental health treatment, prevent PPD or treat it. You can see a counselor with your partner or has individual therapy. Whatever your preference, it’s essential to seek treatment for PPD.

Incarceration and Menstrual Hygiene

Menstrual Hygiene products displayed on a flat surface. — Zubehör für weibliche Hygiene wie Slipenlagen und Tampons auf rosarotem Hintergrund. Source: Marco Verch, Creative Commons

Menstruation is one of many topics that can be difficult and uncomfortable to talk about but is absolutely necessary, as many people do not have the resources they need to manage menstruation within reach. The WHO-UNICEF Joint Monitoring System defines menstrual hygiene management as being when people who experience periods “are able to use sanitary materials to absorb menstrual blood, change and dispose of these materials in privacy as needed, and have access to soap and water to keep clean.” The struggle for accessible menstrual hygiene management can be found in all parts of the world and is even true of some places you would not necessarily expect. One such place is in prisons, where women often have severely insufficient access to products like sanitary pads and tampons. This problem needs to be addressed, as menstrual hygiene products are a necessity. They are not merely items of luxury and should never be treated as a privilege.

However, things are slowly but surely improving. The First Step Act that was enacted in December of 2018 requires the Federal Bureau of Prisons to provide pads and tampons at no cost to the prisoners. While this is a good step forward, it only applies to federal facilities and does not help in state or local ones. Further change continues to be imperative.

Examples of the Problem

Betty Ann Whaley, who was released from the Rose M. Singer Center on Rikers Island in June of 2016, told the New York Times that pads were available “seven out of ten times,” and tampons were even less accessible. It is important to remember that even a nine out of ten times availability would be a serious problem, given the impact it can have on one’s health when menstruating without the means to deal with it.

Even when pads are available, they are often very thin, requiring them to be changed frequently. This leads menstruation to still be difficult to manage, as women in prison often only have access to a small number of pads each month. Chandra Bozelko, who spent some time at York Correctional Institute in Niantic, Connecticut, wrote about her experience with menstrual hygiene management for the Guardian in 2015. Each two-person cell was given five pads each week, giving each woman about ten pads per month. If a woman’s period lasts for five days, she would only have two pads for each of those days. This would not be enough, even if the pads were of high quality.

Topeka K. Sam developed blood clots while she was in prison, meaning she needed sanitary pads that were more absorbent than those available in the commissary. In order to get the menstrual hygiene materials that she needed, she was forced to prove that they were a necessity. She put one of her used pads into a bag and a male staff member determined that she truly needed different pads. Five months had passed by the time she had access to resource she needed.

In some cases, there are even monetary barriers that prevent women from being able to properly manage their menstrual hygiene. Prior to the establishment of the First Step Act, federal prison commissaries charged $5.55 for two tampons and $1.35 for two panty-liners. This is a far greater amount of money than either of these products are worth. For example, you can buy an 18-count box of tampons for $9.19 at Walmart.

Menstrual Hygiene Management in Prisons Is an International Concern

Menstrual hygiene materials are also often difficult to access outside of the United States. In the Bom Pastor women’s prison in Recife, Brazil, Human Rights Watch (HRW) found a few different factors that make proper menstrual hygiene and healthcare difficult. As of March of 2017, tampons had not been distributed to the women since 2015. Water was only available three times each day, which is a barrier to strong menstrual health. There is a risk of infection if there is a lack in adequate soap and water for keeping clean. The prison system of Brazil also only employed 37 gynecologists in 2017, which means there is less than one for every 900 women in the system. HRW also found that 630 women had been placed in a cell that was only built to hold 270. This absence in any privacy and presence of practically no space makes even the act of replacing sanitary products difficult.

According to one study, prisons in Zambia leave inmates responsible for many of their basic- necessities such as menstrual hygiene products and soap. One woman living in a Zambian prison stated, “If others don’t bring them for us, we have nothing. There are lots of people with no relatives here. They have nothing.” The water that is available is often unclean, so they have inadequate ability to keep clean as well. These prisons also have the same overcrowding problem as the Bom Pastor prison, being more than 300% over capacity.

A slightly open jail cell door. — Untitled. Source: Neil Conway, Creative Commons

Impacting Health

Ignoring menstruation is not an option. Not only would that be extremely uncomfortable, but it is also a health and safety issue. Lacking access to necessary menstrual hygiene management materials can have an impact on both the mental and physical health of women living in prisons. In terms of physical health, women who are trying to deal with menstruation while incarcerated might develop health problems such as bacterial infections from trying to use other materials in place of regular menstrual hygiene products.

In terms of mental health, being denied the things one needs to deal with menstruation is a dehumanizing experience. At this point in time, talking about menstrual hygiene feels awkward and uncomfortable for many people. This fact does not change among incarcerated populations. When you add experiences like that of Topeka K. Sam, having to prove that she needed the resources she was asking for, the situation becomes even more difficult.

Why Does It Matter?

Truly accessible menstrual hygiene management resources are undoubtedly a human rights issue. According to Article 25 of the United Nations’ Universal Declaration of Human Rights (UDHR), all people have the right to a standard of living that sufficiently supports their well-being and health. The harm that can be done to one’s physical and mental health when they lack the menstrual hygiene products they need gets in the way of this right.

Potential Solutions

How do we improve menstrual hygiene management in prisons?

The people who are most aware and likely care the most about this issue are people who have been disenfranchised, as only two states allow people convicted of felonies to keep their voting rights, and only 15 states automatically restore their voting rights after they have served their sentence. Additionally, many people would not have the resources they would need to advocate for change, no matter how strong their drive or greatness of their ideas. It would be helpful in trying to solve the problem if we could figure out a way to empower people who have direct experiences with it.

Prisons could potentially switch from providing disposable menstrual hygiene products to reusable ones, like Thinx or Lunapads. While the initial change would be relatively expensive, it would save them more money in the long run, as they would not have to constantly buy more sanitary pads and tampons. This option could significantly improve menstrual hygiene management in prisons, and, as a bonus, it would also be much better for the environment.

Improving this issue is an important step in ensuring that people who have been incarcerated are still treated with dignity and respect as human beings. People are people, no matter what they have done in the past. There is no reason to treat anyone as less than human or prevent them from having access to their fundamental human rights.

If you have an interest in learning more about the need for improved access to hygiene management, check out this post on MHM!