Reproductive health, at home and abroad

Background:

Around the world, women and individuals with female reproductive systems 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 - mothers dying because of complications related to pregnancy or childbirth - in parts of the United States and other parts of the world. 

This lesson looks at seven 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 parents who need to take time off from work to care for newborn children in Denmark and all over the world. 

The articles showcased 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:

1. Analyze stories that capture the policies, cultures, and attitudes surrounding reproductive health in different communities. 
2. Evaluate Challenges women face in accessing healthcare resources, and 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. Use the following questions to continue adding to the brainstorm list:
   1. Who do you think is affected by “reproductive health?” Only women? Women and men? Women and children? What about people who identify their gender in other ways? What are some ways people are directly affected by this issue?
   2. What places in the world or the country come to mind when you hear the word “reproductive health?” Do you think of any specific place, or none at all? 
3. Use the brainstorming session to come up with a class definition of what you think defines reproductive health. Try and make the definition at least two sentences. 
4. Then, compare the definition you come up with the following definition used by the World Health Organization: 
   1. “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.”
   2. How does this definition differ from the one the class came up with? How is it similar? 
5. Final question: what do you know about attitudes, policies, or laws surrounding reproductive health in your city/state/country? Brainstorm as a class.
   1. 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:
      1. If an individual wanted to access contraception or an abortion, what would their options be?
      2. 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?
      3. Do you think reproductive health is an under reported issue?

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 approach thelist of reporting below. As most stories are fairly long, 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. The article touches on the intersections of race and class in reproductive health - quote the place in the article that speaks to this. 
3. Describe some efforts of anti-abortion activists that are listed in the article.

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

Reporting for this lesson:

1. “Kashmir's Tribal Women Fight the Stigma of Birth Control,” article by Safina Nabi, originally appeared in Nikkei Asia. 
2. “How to Make Abortion Great Again,” article by Anna Louie Sussman, originally appeared in Harper’s Bazaar. 
3. “Ecuador’s Crackdown on Abortion Is Putting Women in Jail,” article by Zoë Carpenter, originally published in The Nation
4. “The End of Babies,” article by Anna Louie Sussman, originally published in the New York Times.
5. “Some Harsh Truths About the Life of a Black Abortion Doctor in the Deep South,” story by Laura Bassett, originally published in the Huffington Post. 
6. “In Poland, Midwives Play a Significant Role in Childbirth. In Texas? Not so Much.” Article by Marissa Evans, originally published in The Texas Tribune.
7. “Virginity Testing in Morocco: Assault on Dignity, or a Shield Against Assault?” Article by Samidha Shane, originally published in Global Health Now

Bonus reporting:

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

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 barriers, social barriers, religious barriers, financial barriers, or gender-based 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?
5. What do you think the country/community highlighted in the story you chose to read will look like in the next 10-15 years? If you think things will be different or not different, why?

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.?
   1. What are some barriers that you see in our community that prevent women and other individuals from accessing reproductive healthcare? If you do not see any barriers, why do you think that is?
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
• US 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
• 2018-2020 data on Americans identifying as “pro-choice” or “pro-life” by Gallup

Extension activities:

1. Letter to a policy maker: Consider the articles you chose to read and the specific circumstances surrounding reproductive health in that country/community. Is there anything that you think policymakers, judges, or activists in that country should be informed about? Draft a letter to them, or to your own Congressperson or another local policymaker, using the steps below. 
   1. Research the best person to write to. If you are keeping your focus on your own community, consider writing to the Senator or Congressperson who represents your state/district. If you want to focus on one of the countries you read about in the reporting, consider searching for a Minister of Health or local activist.
   2. In the letter, start by introducing yourself, and let the person you are writing to know what you think about this issue. 
   3. If you think there are problems surrounding reproductive health in this person’s community, let them know and provide evidence from the stories you read. Give them suggestions on how you think these problems can be addressed.
   4. Research the proper format for a letter to a policy maker and submit the final product to your teacher. 
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.. 
   1. 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:
      1. Where did you find this source - which platform? Was it coming from an individual or from an organization, institution, or political figure? 
      2. What did this source have to say about reproductive health? Is it trying to mislead or misinform its audience in any way?
      3. If yes, how would you correct the information in this post? Why do you think someone took the time to make this post when the information in it is not true?
      4. If the information is true and not misleading, did you find this information surprising and/or helpful? 
3. Research: Examine reproductive and women’s health in the context of COVID-19 : consider the reporting you looked at for this lesson. Next, read one of the bonus articles which considers issues related to women’s health and COVID-19. 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. 
   1. How did COVID-19 specifically affect maternal and reproductive health for people who were pregnant, new mothers, or breastfeeding? 
   2. How have women been impacted - personally, physically, financially - by the pandemic? 
   3. How does this issue intersect with race, class, and other issues?

Bonus reporting:

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