Reproductive health, at home and abroad

Introducing the Lesson:

Around the world, women and gender diverse people face distinct barriers in accessing reproductive and other healthcare services. This can range from stigmas surrounding deliberate family planning interventions such as contraception or access to abortions, to high rates of maternal mortality - people dying because of complications related to pregnancy or childbirth. 

This lesson looks at ten different stories from seven different countries. Each reporting story featured provides a look into the legal, political, and cultural attitudes surrounding reproductive health issues ranging from virginity tests in Morocco to access to abortion in Ecuador to parental leave for people who need to take time off from work to care for newborn children in Denmark and all over the world.

The articles explored in this lesson offer a look at both individual perspectives and broader, country or statewide attitudes towards reproductive health. The goal of this lesson is to provide an overview of these issues both “at home” and “abroad,” and to make local and global connections that will help us to deepen our understanding of these issues at both the macro and micro levels.

Objectives:

Students will be able to...

1. Analyze stories that capture the policies, cultures, and attitudes surrounding reproductive health in different communities. 
2. Evaluate the gendered nature of certain healthcare disparities. 
3. Draw local connections to the stories they will read, and to articulate the similarities and differences between their own communities and Kashmir, Ecuador, Poland, Amsterdam, or Morocco. 
4. Compare and contrast the content in different pieces of reporting, and subsequently compare and contrast systems surrounding reproductive health in different parts of the world.

Warm-up:

Note to teacher: This can be done in a whole-class setting, with the teacher writing on the board. Students can also create graphic organizers of their own and work in groups of 5-6.

1. Brainstorm and list: what words or phrases come to mind when you hear the phrase “reproductive health?” What do you think this phrase means?
2. Compare the class definition with the following, used by the World Health Organization: Reproductive health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity, in all matters relating to the reproductive system and to its functions and processes. Reproductive health implies that people are able to have a satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so. How does this definition differ from the one the class came up with? How is it similar?
3. Who do you think is affected by “reproductive health?”
   • How do you think women, men, children, cis people, trans people, nonbinary people, etc. are affected?
   • How might other aspects of people's identities and circumstances, beyond gender, influence how they are affected? (Think about race, socioeconomic status, religion, country or state of residence, etc.)
   • What are some ways people are directly affected by this issue? 
4. Final question: What do you know about attitudes, policies, or laws surrounding reproductive health in your city/state/country? Brainstorm as a class.
   • Note to teachers: If students do not know too much about local policies surrounding reproductive health, encourage them to use online research to supplement their brainstorming. Ask prompting questions such as:
     • If an individual wanted to access contraception or an abortion, what would their options be?
     • Where have you heard terms like “abortion” or “birth control” on local news? Or have you never heard anything - would you say this is an issue that people don’t really talk about?
     • What reproductive health issues and stories do you hear a lot in the news? What reproductive health issues do you think might be underreported?

Vocabulary:

• Reproductive health
• Abortion
• Family planning
• Contraception
• Pro-life
• Pro-choice
• Maternal health
• Maternal mortality

Introducing the Reporting

Note to teachers: There are multiple options for how to explore the list of reporting below. Teachers can ask students to take independent reading time after the warm-up period. Or, students may receive these readings as take-home assignments which they will return with their notes and comments to their teacher. The instructions below offer one way of structuring students’ analysis of the reporting.

1. Ask students to choose at least two pieces of reporting from the list below to read. They should be able to articulate, after reading the articles (whether or not they are assigned as homework), a few basic notes about them. 
2. For comprehension, students can fill out the following graphic organizer for each article they read.
3. Let students know that they will each be reading an article that is focused on a different country/community, and to expect to share a few notes about what they are reading in class discussion.

If time permits, read one article as a class and have students examine another independently or in groups. If you are able to go over one article in class, such as “Kashmir's Tribal Women Fight the Stigma of Birth Control,” ask guiding questions such as:

1. What national health policy did the Indian government pass in 2017?
2. What is a stigma surrounding family planning or birth control that is mentioned in the article?
3. What is “missing” from the approach of the Indian government toward reproductive health for the Gujjar and Bakerwal women in Jammu and Kashmir?

You can also read “Some Harsh Truths About the Life of a Black Abortion Doctor in the Deep South,” and ask the following questions:

1. Dr. Willie Parker describes several challenges facing individuals attempting to access abortions in the American South. What are some of these challenges?
2. What does this article suggest about the intersections of race and class in reproductive health?
3. Describe some tactics of anti-abortion activists that are listed in the article.

Ideally, the class will read one article together and one or two other articles independently. 

Reporting for this lesson:

1. “Kashmir's Tribal Women Fight the Stigma of Birth Control” by Safina Nabi in Nikkei Asia. [India]
2. "With Roe v. Wade on the Line, Some Texans Look South of the Border for Abortion Drugs" by Eleanor Klibanoff, Uriel J. García, and Mitchell Ferman in The Texas Tribune. [U.S., Mexico]
3. "Many Students in Puerto Rico Suffer from Menstrual Injustice. Here’s How Activists Want To Help." by Adriana Rozas Rivera in The Lily. [U.S./Puerto Rico]
4. “How to Make Abortion Great Again” article by Anna Louie Sussman in Harper’s Bazaar. [Poland]
5. "Pills in the Post: How COVID Reopened the Abortion Wars" by Sarah Hurtes in The Guardian. [United Kingdom]
6. “In Poland, Midwives Play a Significant Role in Childbirth. In Texas? Not so Much.” by Marissa Evans in The Texas Tribune. [Poland, U.S.]
7. “Ecuador’s Crackdown on Abortion Is Putting Women in Jail” by Zoë Carpenter in The Nation. [Ecuador]
8. “The End of Babies” by Anna Louie Sussman in the New York Times. [Denmark]
9. “Some Harsh Truths About the Life of a Black Abortion Doctor in the Deep South” by Laura Bassett in the Huffington Post. [U.S.]
10. “Virginity Testing in Morocco: Assault on Dignity, or a Shield Against Assault?” by Samidha Shane in Global Health Now. [Morocco]

Reflection and Discussion:

Now that students have each read at least two pieces of reporting on reproductive health around the world, they can begin to compare and contrast what they have read, as well as to draw connections to their own communities. 

Step 1: Review and summarize the articles

Encourage students to share the headlines for the stories they read and to give a brief summary for the class. You could also allow students to form groups based on which additional reporting they chose to read and ask them to discuss the following questions:

1. Describe the reporting you chose to examine: What was the article about? How would you describe the central theme?
2. What new information did you learn about reproductive health from this article? Was any part of what you learned surprising to you? Why or why not?
3. According to the reporting, what are some barriers individuals face in accessing reproductive healthcare in the community being described? Consider legal, social, cultural, religious, and financial barriers. Why do you think that these obstacles exist at all? What systems uphold these barriers?
4. Reflect on barriers to reproductive health access in the community you read about. What do you think are some potential solutions to helping people overcome these obstacles?

After discussing the articles that they read, ask students to present their findings to the class. As students share their reflections, the teacher can make notes about different pieces of reporting in a shared class document that is projected to the group. Go article by article.

Step 2: Compare and contrast the articles

Next, move into a compare and contrast reflection. Pose the following questions and ask students to provide their answers in a whole-group setting:

1. What barriers did the individuals you read about face when trying to access reproductive health resources? In what ways were those individuals supported?
2. How were the experiences of the individuals you read about alike? How were they different?
3. How were the experiences of the people in the countries you read about influenced by laws related to reproductive health? Policies? Public attitudes?
4. Think about the brainstorming we did about local attitudes in our own community towards reproductive health. Do you think individuals here face similar obstacles in accessing reproductive health resources such as abortions, contraceptives, etc.?
   • What are some barriers that you see in our community that prevent people from accessing reproductive healthcare?
5. Have you heard American politicians, policymakers, or judges speak about reproductive health on TV or other news? What have you heard them say? How does that compare to what you heard public officials say in the articles you read?
6. Based on the articles you read, what are some reasons a country would want to improve access to reproductive health? What do they stand to gain if more people are able to safely access abortion or other family planning resources?
7. How would individuals themselves benefit from this type of improved access?
8. In some cases, in state governments in America or in other countries, people actively work to make it harder to access reproductive healthcare and those resources. Why do you think this is? 
9. When considering the articles you have read, either independently or with the whole class, what information or perspectives would you have liked to see included that perhaps felt “missing”? 
10. Has this lesson changed the way you think about anything in your own community or in the world at large? If so, how? And if not, why?

External resources:

These external resources can be used to supplement student learning and research at different points in the lesson. They can look through these resources in the research portion of the warm-up activity, or when discussing reporting in their small groups, or after the discussion and reflection portion of the lesson if they want to learn more about reproductive health.

• Data and Statistics from the Center for Disease Control (US Specific)
  • Reproductive health “fast stats”
  • Contraceptive “fast stats”
  • CDC Abortion Surveillance
• U.S. Abortion Laws, explained by the Guttmacher Institute
  • State legislative tracker tracking updates to laws and regulations surrounding reproductive health across the United States 
• Maternal and reproductive health homepage by the World Health Organization
• 2018-2021 data on Americans identifying as “pro-choice” or “pro-life” by Gallup

Extension activities:

Option 1: Letter to a policy maker: Consider the articles you chose to read and the specific circumstances surrounding reproductive health in that country/community. How do these issues connect to your own community? What do you think policymakers can do to help ensure equitable access to reproductive health care? Draft a letter, using the steps below.

• Research the best person to write to. Consider writing to a city council member, or the senator or congressperson who represents your state/district. You might also consider a person who specializes in health care: a secretary of health, a local activist, etc.
• Consider exploring this 10th grade student's letter about abortion access as an example of a persuasive letter to a policymaker.
• In the letter, start by introducing yourself, tell the person why you are writing, and share the action(s) you would like them to take.

Option 2. Evaluating misinformation: There is a lot of misinformation on the internet about different aspects of reproductive health. Sometimes this can look like people giving bad health advice that is not backed by scientific research. Other times, misinformation can have a political intent. Go onto a social media platform of your choice - it can be Instagram, TikTok, Twitter, YouTube, etc. and find 3-4 posts related to reproductive health. Then, evaluate whether the post is showing an example of misinformation. You can start by searching keywords that we discussed in class: reproductive health, abortion, birth control, family planning, maternal health, etc.. 
Once you find 3 or 4 posts, write up a report about your findings. You can write a short paper or use a graphic organizer to describe the following:

• Where did you find this source - which platform? Was it coming from an individual or from an organization, institution, or political figure? 
• What did this source have to say about reproductive health?
• What is the purpose of the post? (To inform? To persuade? To incite action?) What feelings do you think the author wanted people who saw the post to experience?
• If there is misinformation in this post: How would you correct the information? Who might the misinformation benefit, and who might it harm?
• If there is no misinformation in this post: Did you find this information surprising and/or helpful? Who might this information benefit, and who might it harm?

Option 3. Research: Examine reproductive health in the context of COVID-19. Read one of the articles below, which consider issues related to reproductive health and COVID-19.

• “The Coronavirus Vaccine Presents a Dilemma for Pregnant Women” by Anna Louie Sussman in the New Yorker.
• “After COVID: Feminist Policies Save Lives and Uphold Rights” by Lina Abou-Habib in Daraj.

Create a short write up or presentation (could be a PowerPoint, or a podcast where you record a concise summary of the issues and your thoughts on them) about how the pandemic has affected access to reproductive health in your own community or around the world. 

• How did COVID-19 specifically affect reproductive health for people who were pregnant, new parents, or breastfeeding? 
• How have women and gender diverse people been impacted - personally, physically, financially - by the pandemic?
• How does this issue intersect with race, class, and other elements of identity and circumstance?