Bipolar and pregnant

Thank you to guest blogger Zoe for allowing us to share her thoughts on the recently reported case of a woman who was granted legal access to abortion following a challenge to her ability to consent. This is cross-posted on Zoe's own blog 'The Fementalists'.

Today a woman, identified only as “SB”, won her High Court battle to be allowed to have an abortion. This fact may seem strange to many readers as since the Abortion Act was passed in 1967 legal abortion has been mostly accessible to women in England, Scotland, and Wales . However, the woman at the centre of this case has bipolar disorder and it was argued by doctors and her family that she lacked mental capacity to consent to the procedure. Lawyers representing the health authority told the judge “she is believed to lack the capacity to make a decision regarding the termination of her pregnancy due to her mental disorder.'' Fortunately, the judge disagreed with this assessment, stating that it would be "a total affront" to her autonomy to decide that she was unable to have an abortion.

I have been following this case closely as I also have bipolar disorder and as a young woman with a male partner I worry a lot about the possibility of an unplanned pregnancy, to say nothing of worrying about what my future holds in terms of planned pregnancy. It was stated in the Court that the woman in this case had stopped taking her medication and thus relapsed, culminating with her being detained under the Mental Health Act. However, many medications for bipolar are not suitable to take when pregnant as they can cause birth defects such as neural tube defects, heart defects, and developmental delay or neurobehavioural problems. Thus many people have to stop taking their medication if they wish to continue with their pregnancies. This is believed to be what happened in the “SB” case. While this may seem like a relatively minor thing, the consequences of this can be devastating. Rates of relapse into bipolar mania and psychosis are estimated at 50% to 75% respectively and WebMD states that “Pregnant women or new mothers with bipolar disorder have seven times the risk of hospital admissions than pregnant women who do not have bipolar disorder.” So clearly the risk of being detained under the Mental Health Act also greatly increases during pregnancy because of the additional problems caused by stopping medication.

For me, this represents the nightmare scenario. Finding myself pregnant with a wanted foetus only to stop my medication, relapse and be detained under the Mental Health Act, and to then decide that for my own health I would like a termination and be denied it because it is argued that I lacked capacity. It is truly a terrifying prospect to find yourself unable to control your own body because you have a mental illness. Much more needs to be done to provide perinatal care for women with severe and enduring mental illness to ensure that a situation like this never arises again. Fortunately in this case the judge has made the right decision and SB is expected to have an abortion in the following days. Arguably, this situation should never have arisen in the first place.

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The effect of homophobia and transphobia on universal access to reproductive health

Today is IDAHO, otherwise known as ‘The International Day Against Homophobia and Transphobia’. We decided to blog about the relevance of reproductive rights to people of all (or no) genders and sexualities, and some of the problems those who identify as LGBT* can face in accessing sexual and reproductive health services and relevant information.

Why are reproductive rights important for people of all genders and sexualities?

When I tell people I work on a project which educates young people on pregnancy options they’ve asked if we only visit girls’ schools, and have expressed skepticism at the usefulness of covering this topic at a workshop for LGBT* youth. At EFC we believe everyone has a stake in understanding how reproduction works, and how people can be supported to make decisions about sex, contraception and pregnancy that are right for them. Here are some thoughts on why this is a subject which breaks though cisgendered/heterosexual ‘norms’:

-    Most people with a womb have at least the capability to get pregnant at some point in their lives. Even those who don’t choose to have vaginal intercourse can become pregnant, for example through sperm accidentally coming into contact with the vagina through non-penetrative intercourse, or as a result of rape.
-    Research has shown that young people who identify as gay, lesbian and bisexual may in fact be at a higher risk of unplanned pregnancy than their heterosexual peers. Stigma surrounding sexuality can lead some young people to ‘prove’ heterosexuality through sexual contact with a partner of the ‘opposite’ sex.
-    As Thomas Beatie has shown with his high-profile pregnancies, trans men and transmasculine people can and do become pregnant and may require specific information on this process.
-    Those who are unable to conceive in what is often seen as the ‘natural’ or ‘traditional’ way, may decide to access services which allow them to become pregnant (e.g. IVF) or to become parents through other means (adoption, fostering and surrogacy).
-    People who cannot themselves become pregnant may have close contact with those who do, whether it be a partner, family member or friend.
-    Many of the individuals and groups which seek to restrict abortion access also argue against LGBT* rights – for example, anti-choice group SPUC is currently running a campaign against equal marriage and has claimed that ‘making homosexual couples the legal parents of children is not in the best interests of children’.

What are some of the barriers for people who are LGBT* in accessing reproductive health services?

Outright stigma, and homo/trans/biphobia is a clear barrier for equal access to services. The stories gathered by #transdocfail showed systematically poor treatment of trans* people in health services, likely to be reflected in consultations relating to sexual and reproductive health. Media outrage and sensationalised headlines relating to LGBT* parenting are unlikely to make those who identify as such eager to access support and services. And as well as stigma, there may be legal restrictions to reproductive rights – the Swedish government has only just vowed to remove a statute which requires all transgender people to be sterilised in order to have their gender recognised legally.

Beyond direct objection to equal reproductive rights, there is also often a lack of tailored resources and information for those who are lesbian, gay, bisexual and/or transgender. In our own work we are trying to address this by using language that is inclusive, and thinking of ways to address gaps in resource provision, making links between the reproductive rights and LGBT* rights movements where possible. Thankfully, some progress is being made – we’ve listed some useful resources below but please do add your own comments and suggestions.

Useful resources

• A brilliant book for talking to children about ‘where babies come from’ which doesn’t make assumptions about gender and sexuality
• The Terrence Higgins Trust has produced sexual health resources for trans men and trans women 
• Stonewall’s ‘A Pregnant Pause’ provides advice ‘for lesbians on how to get pregnant’ 
• 9 Facts about Trans Sexual and Reproductive Health (U.S resource) 
• The Transcending Anatomy blog has specific information on pregnancy
• Blog from Abortion Gang entitled ‘Why queer justice and reproductive justice movements should work together’

Todd Akin's not the only one claiming that pregnancy as a result of rape is rare

Earlier this week Republican politician Todd Akin came under fire for claiming that pregnancy occurring as a result of rape is ‘really rare’. In arguing for a ban on abortion without exceptions for pregnancies conceived through rape he stated the following:

“First of all, from what I understand from doctors [pregnancy from rape] is really rare... If it’s a legitimate rape, the female body has ways to try to shut that whole thing down”

Akin’s claims have rightly been attacked by various pro-choice groups and media outlets in the States for having no basis in scientific fact. Indeed, research from the Journal of American Obstetrics and Gynecology suggests that rape-related pregnancy occurs with significant frequency, something to which many women themselves can attest. So huge was the outcry that even the President released a statement condemning the claim that “legitimate rape” is unlikely to end in pregnancy. President Obama used Akin’s disingenuous comments as an example of why "we shouldn’t have a bunch of politicians, the majority of whom are men, making healthcare decisions on behalf of women."
 
Unfortunately, this kind of thinking isn’t limited to one rogue politician in the States spouting misinformation in order to push a ban on abortion. The idea that it is impossible or very unlikely for pregnancy to occur as a result of rape has been spread by a number of anti-abortion groups, including those based in the UK. The Society for the Protection of Unborn Children (SPUC) state the following in their ‘Exploring Abortion’ school resource:

“Pregnancy as a result of rape is extremely rare. A woman is only fertile for 3-7 days during her cycle and the extreme physical and psychological trauma of being raped makes it difficult for fertilisation or implantation to occur.”

Earlier this year, SPUC were criticised for giving young people misleading information about pregnancy and rape but we are yet to see the same public outcry Todd Akin’s comments have attracted in the States.

Young people here and abroad deserve to hear factual information about pregnancy and abortion, and we should certainly be concerned when damaging myths like this are allowed into our classrooms. EFC are currently working on a report into abortion education in the UK which will pull together the types of misinformation being given to young people in schools. If you have information you'd like to feed into the project please do contact us efc@brook.org.uk and keep an eye out for the launch of the report this autumn.

EFC Youth Advisors produce short film about pregnancy testing

We're very pleased to announce that the short film produced by our lovely Youth Advisory Group is now up on our You Tube channel (and you can view it below!)

The group wanted to make a film which would give other young people information about pregnancy testing and pregnancy options but which would also make the process seem a little less intimidating.

Chau: 'I have definitely learned more about sexual health and am able to tell others more precise facts'
Namratha: 'It's a great resource for young people to know of their concerns and options locally available to them'
Nataliah: '(the film allows) young people to gain information on services available to them without feeling embarrassed or intimidated to directly ask someone.'

Well done guys!

Young women, pregnancy and domestic violence

A new study from the University of Bristol and the NSPCC represents the first UK research to focus on disadvantaged young people’s experiences of violence and control in their intimate relationships. The report gives some depressing statistics about pregnant young women and young mothers’ increased exposure to domestic violence. Two thirds of those interviewed had experienced physical violence in at least one of their relationships and nearly all reported some form of controlling behaviours from their partners.

As the report points out, ‘an increased risk of domestic violence, in both pregnancy and after birth, is something universally experienced by women, irrespective of age or disadvantage. However, a young mother’s age, alongside the social stigma associated with teenage pregnancy, profoundly impacts on young women’s ability to protect both themselves and their children’.

The Include study mentioned in the report found that ‘young women are less likely to access services than other women and have fewer resources to help them leave relationships’. Some young mothers were reluctant to leave their partner and be seen as fitting into the stereotype of a ‘young single mum’. Another concern, which we’ve also heard anecdotally from professionals working with young people is that young mothers are afraid to report domestic violence for the fear that their child(ren) may be taken away from them.

Beyond the physical violence done to women during or post-pregnancy there is research to suggest that some young women are also victims of ‘reproductive coercion’. That is to say, their ability to control the sex they have, the contraception they use or the reproductive choices they make (such as whether to continue or end a pregnancy) is controlled by a male partner. This report makes clear that ‘for some young women pregnancy was not a personal choice due to their experiences of sexual violence and coercion’. Arguably, the choice to continue a pregnancy or to have an abortion may also be one which is heavily influenced by a controlling partner.

So what can be done? The NSPCC report recommends that work is carried out which challenges negative stereotypes around teenage pregnancy and that greater awareness of the issues relating to domestic violence and young pregnant women is encouraged. The Include research found that the majority of young women were accepting of screening for domestic violence during antenatal/abortion appointments and provided this is done sensitively and with thorough training it provides a chance to pick up on any violence or coercion a young woman may be facing.

There are some great charities such as Tender delivering educational work on domestic violence to young people. This sort of work seeks to raise awareness about what domestic violence is and challenge some of the gendered and societal assumptions which can form silence and acceptance around it. At EFC we’ve long been arguing (alongside most of the young people we meet!) that more attention needs to be paid to the ‘R’ in SRE. By giving young people a better grasp of what a balanced, safe relationship looks like we give them the tools to recognise coercion, and hopefully find professional help and support should they need it.

‘Men have wombs too'

There were some great banners at the pro-choice demo on Saturday: see our photos of them here on Flickr. But one which stood out was a simple sign proclaiming that ‘men have wombs too’. Today’s blog attempts to unpick this slogan and look deeper at the intersections between pregnancy, sex and gender.

When most people talk about pregnancy they tend to focus on a female-born, female identified ‘woman’, generally assuming that this pregnancy has occurred because of penetrative sex between a ‘cis man’ and a ‘cis woman’ (see Scarleteen and Bish for a full explanation of ‘gender’ terms). These two people are also often assumed to be straight (see previous LGB blog for more on pregnancy and sexuality). Whilst this may indeed be the case the majority of the time, at EFC we think it’s really important to acknowledge the fact that some ‘men have wombs too’. But what exactly does this mean?

When delivering our Talk About Choice sessions in schools, more than once I have had young people ask me ‘if men can get pregnant’. There’s generally a titter, and somebody will reference a TV show in which they’ve seen a ‘pregnant man’ to back up their point. What these young people are generally referring to are trans men who have conceived and given birth. That is, someone who was born into a body typically read as ‘female’ but whose gender identity is male. Not all those who feel this discrepancy between their assigned sex and their lived gender will undergo full surgery (commonly known as ‘a sex change’ in the media) but some may choose to take hormones to affect secondary gender characteristics such as facial hair and a deeper voice, or may have a mastectomy and/or hysterectomy.

Some trans men retain their female reproductive organs and are able to conceive and carry a pregnancy to term, although they may have an outwardly masculine appearance. Thomas Beattie is an example of a trans man who has ‘gone public’ with his pregnancies although of course many more trans men become pregnant without such media attention. Trans men of course may choose to terminate a pregnancy, hence the banner which called out for the right to choose for all those who can become pregnant, male or female.

We believe it’s important for young people to acknowledge and understand the implications of sex, gender and sexuality with respect to pregnancy and are keen to address the diversity of those who are affected by pregnancy, abortion and childbirth.

Myth-Busting Monday: All independent pregnancy advice centres offer women impartial, balanced pregnancy decision-making support

Since Lisa wrote a blog about Nadine Dorries and Frank Field’s ‘Right to Know’ campaign and their proposed amendments to the Health and Social Care Bill we’ve seen the issue discussed by a number of journalists and bloggers. In light of that, today’s Myth Busting Monday focuses on one particular aspect of this campaign which we believe could pose a real threat to women’s access to impartial support with pregnancy decision-making, and that is the presence of unregulated pregnancy advice centres.

The Right to Know site claims that:
An amendment to the Health and Social Care Bill would guarantee that all women considering abortion have access to independent advice and counselling - provided by someone with no vested financial interest in the outcome of their decision.

Our question is – just who would be providing this service? What is the alternative for a woman who doesn’t speak to her doctor or a counsellor at an abortion provider?

Crisis Pregnancy Centres (CPCs)
There are already a number of independent pregnancy advice centres across the country. Some are upfront about operating with a specifically anti-abortion agenda, some aren’t. Some are transparent about religious affiliations or funding organisations, some aren’t. Some may be providing evidence-based information and impartial support to women facing an unplanned pregnancy but we know of many more which aren’t. Our own research, coupled with the insight of the many professionals we speak to across the UK suggests that a good number of these centres are not offering women a balanced discussion of their pregnancy options but rather serving misinformation, health myths, overblown statistics and, in some cases showing women anti-abortion videos. This Channel 5 news report gives an idea of the kind of misleading information which may be given by a CPC.

Our concern is that suggestions that women need to look for independent pregnancy advice could open up the capacity of centres which offer biased information, driven by an agenda. Perhaps not the ‘financial incentive’ Dorries accuses abortion providers of, but an agenda nevertheless.