Transcript: reproductive health under Lockdown


English transcript of the podcast: Feminism is systemically relevant #001 - Reproductive health in lockdown.

feminismus ist systemrelevant

GWI Podcast – Feminism is essential

Episode 1: reproductive health under Lockdown

Podcast Transcript – 3/06/2020

Derya: Hello everybody and welcome to the first episode of our new podcast series “Feminism is essential”. I am Derya Binisik and I am the Senior Program Officer for Reproductive Justice and Bodily Autonomy at the Gunda-Werner-Institute of the Heinrich Böll Foundation. The Covid-19 Pandemic certainly put large parts of our lives on hold for a while. It probably still does. But there are things that this pandemic cannot stop from happening. Like, for example, people getting pregnant or people wanting to get pregnant or people wanted to get rid from pregnancies. Access to contraception, abortions, fertility treatments and safe birth in Germany is often restricted by ministerial barriers, as well as class, race and gender related discrimination. And as this pandemic already taught as, things that were difficult before Corona, certainly will not be easier now. The right to bodily autonomy and reproductive health appears once again to be very fragile. Today we want to take a closer look on how the pandemic is affecting reproductive health but also how it might bear some potential for positive transformations in the field of reproductive justice in Germany. But I do not want to talk about this alone, instead I Invited two experts to talk about this with us. I am here with Jane and Stephanie and I give the word to you to introduce yourselves.

Jane: Thank you for having me here my name is Jane Wangare. I am an activist in a self-organized refugee women group, by the name “Women in Exile”. My main work is to fight for the refugee women’s rights.

Derya: Ok. Thank you Jane for coming. Hello Stephanie.

Stephanie: Hi. I am very pleased to be here with you. My name is Stephanie Schlitt, I am on the board of Pro-Familia, the Germany wide network of counseling institutions which provide counseling on sexuality and reproductive health matters and in my professional life I work as a researcher in the German parliament. And my background is in gender and women’s right with many years at Amnesty International and at the World Health Organization.

Derya: Thank you so much for being here. I am very happy to have you here as two experts in this field and I think we will just rightly jump into the topic. My first question is to you Stephanie, from your perspective, how is the pandemic affecting reproductive rights in Germany so far?

Stephanie: Well, as you said in your introduction Derya, I think it is right to say that we were very aware of obstacles to access to reproductive and sexual health services even before Covid-19 called us out. I think what is happening now is that there is an acute awareness that these obstacles have actually potentially worsened, that we need to ask the question whether man and women are finding it more difficult now to access the information and the services they need and I think that as soon as we realize form looking at other countries what Covid-19 would means for us, activists and people in the houses have to sprang into action to see what need to be done. In Pro-Familia, for instance, we got active immediately to put up the counseling service in a digital format for women with unwanted pregnancies especially, to still be able to reach us without having to come in person, so that when offices have to close down because of suspicious cases of Covid-19, or when women themselves cannot leave the house, then they can still have the counseling they need by law in order to access abortion services. That is just one example but I think in the longer term, really the challenge has been to digitize some of the health services but also to see that access is still possible and that the range of services is expanded to make safe services available and really to start from the experience that women and men have, in order to see what safety, what security, what does well-being mean at this time and how can we make sure that we can still access our rights and keep each other safe.

Derya: Thanks. And from your perspective Jane. and your experience from working with the group of “Women in Exile”, how has the pandemic affected reproductive health from your point of view?

Jane: Lately, we feel doubly affected because, as my colleague has already said before, it was not easy eve before for refugee women to access good reproductive health rights. During Covid-19 times, we found that most of them live in the camps, and there was total lock down in some of the camps up to 2 months, where they could not even have access to contraceptive pills and so now they are facing the challenge of being pregnant without wanting the baby. Most of them could not even access the basic "menstrual health" sanitary pads. and they were trying to reach us for help, but this is out of our capacity. We felt that they are doubly affected and it is not easy for these women, specially living in the camps where they are crowded and where also hygiene is not good at all. They have to share toilets, same for both women and men, with other 50 or 100 people. It is really not easy and traumatizing during this Covid-19 times.

Derya: Yes, so both of you actually talked about obstacles that have increased during this pandemic and the regulations that come with it. Can you give me some more concrete examples of what obstacles were already there before, and how the pandemic and the regulations have worsened these obstacles?

Stephanie: One example that it is still trying to get some action on, is access to cost coverage for abortions for women unable to pay. This involves quite a bit of administrative running around in the normal circumstances in order to get the form you need, to have it filled out and to get it to where it needs to go in time, because, as you know, it is essential not to lose time when you are trying to have a safe abortion within the legal limits set on Germany. With the shutdown happening around Covid-19, the offices where you usually get the form that you physically have to fill in, are shut down and those forms are not available online (some now are, but initially they were not). So what does a woman do who is dependent on cost coverage in order to get access to the services, but now must find a way to get the form and get it to the person who corresponds? And all of this physically, so basically our efforts have been to make the health insurance companies put those forms online, but since there are many of them, the more efficient way would be a federal solutions and a federal approach and that is what we have been lobbying for. So even before Corona this was quite a bit of work, and it is definitely worse now, if not impossible. 

Derya: And from your point of view, what obstacles have worsened, if you can give concrete examples of your experience?

Jane: For us, I think, it was not because before most of the refugees did not have insurance covers, so it was from the beginning very difficult for them to access reproductive health. Then, those even who have, but their status is still not clear, cannot access a facility or medication. And when they really want to have access, it is very expensive and also, since the insurances they often have are only temporary, it is very difficult with the gynecologist to settle this. There was also the case of canceling. When it comes to abortion, all of them are sent to Caritas, they are not allowed to receive counseling from other centers. In Caritas, most often, the counseling they receive is biased in addition to receiving a feedback, persuading them sometimes to keep the baby, when it was not the initial wish. This is really a challenge. Most of these women also do not have a social insurance because if you do not coordinate with the Auslander Behörde or with the authorities, there is the cut of money and then maybe get a Gutschein, but yet you cannot buy contraceptive pills with this Gutschein. It is very difficult. Those are then some of the obstacles that the refugees face.

Derya: As you both said, it was interesting and sad to see the whole range of reproductive services, like contraception, fertility therapy and abortion, are being really affected by this, and have been already in a bad state before. What about giving birth? Do you have any information or experience about this situation in the delivery rooms under the pandemic?

Jane: I did not hear. From our case, we have no woman who gave birth. But during this time we have so many women who are pregnant and most of them will deliver in a camp which it is not so far away from here. It is in Hennigsdorf. There they went into a total lock down for two months and pregnant women could not access to gynecological tests or many other services. Anyways, we did not have any new baby yet during this Covid19 times. 

Stephanie: There have been reports in the media saying that some hospitals have not allowed women to bring their partners or another accompanying person to birth. I think that is something that has had many pregnant women very worried because it is already the case that for many women the process of the birth it is not the best. In some cases, in Germany, there are not enough midwives to make sure that there is somebody there with you at all times during the birth. If you are confronting the prospect of being at hospital and being by yourself during parts of the birth, that would be very unsettling. But I think there has been a lot of attention to this issue and perhaps those policies have been reversed. I also heard that midwives who visit women at home or do womb deliveries, have no access to protective equipment which puts them in a very difficult position. Should they continue with their services but not have the protection for themselves and the families they visit? Or should they stop visiting? Not all of those visits make sense to be done by phone if you have a heavily pregnant woman or a new baby. You need to be there in person. Those are some of the challenges where sometimes you wonder how long away we have to go to really think through these issues from the perspective of the people affected. These are not abstract policies issues. We have to put ourselves in the footsteps of someone who is pregnant during this time and the questions and concerns she may have, and then it is immediately obvious that giving birth by yourself, without somebody accompanying you it is going to be extremely difficult. 

Derya: Yes. definitely. I was also reading up a bit on what the World Health Organization has recommended or has written about how reproductive health services have to be managed during this pandemic. And actually what they say is that health services in the reproductive sector have to be guaranteed, despite Covid-19. So, we already heard some examples where this was not really happening in Germany, but again from your point of view, is Germany complying with these standards? How are other countries doing? This pandemic affects every country but they tackle it very differently. So from your point of view, is Germany doing enough for reproductive rights in terms of the political decisions? and also, how do other countries handle this?

Stephanie: I think it is a tricky question to answer because Covis19 plays out in the same way but also differently, with some time lags between different countries. So we definitely looked to countries which were affected a bit earlier than us to see what the reaction there was, how the health systems responded, how the activists responded and I think there is a feeling here in Germany that things have not turned out so badly yet, and hopefully they won't. In a sense, there is not the same urgency behind some of the policy discussions yet as we have seen in other countries. The association of professionals in the field of abortion and contraception made a short survey of what I think 37 countries in Europe to look at what changed around abortion specifically during the Corona pandemic. You could see that many of them had either started to think about or already implemented measures to reduce the contact points between women seeking abortion services and abortion services' providers, to make sure that abortion would still be safely delivered but in Germany we have raised some of those issues without necessarily seeing much movement. So we are able to do the counseling by digitally or by phone now but, I have already mentioned the example of cost coverage, for instance, where we have not seen any movement yet. There is a sense in which perhaps it has yet not been bad enough here in order for bigger changes to come out, but that is something where I would really like to push back because, I think, how bad does it has to be for us to have this evidence based demands taken seriously. And again, I'd say, put yourself on the shoes of the people who are seeking access to information and services. If they are having a bad experience it is in part because of the uncertainties and obstacles that arise from public domain to tackle those. I mean, the evidence is the experience that people have and that is what we need to respond to.  

Jane: And I think also that Germany is not complying because we have cases from different lagers where we have women who got pregnant during this Covid-19 and they do not know even where to go for counseling. They have no information. They don’t know what to do. They don't know even if they have the right to abortion because they lack information. I think that is a failure of communication and I don't know if it is maybe also language, but the people who are living in the camps have no information. Even during this Covid-19 times, we had expected maybe more information to be given, as well as more deadlines, and all of them being accessible. But what we see is that most of the information is online, when actually the people who need it are in places very isolated, a lot of times in middle of forests where there is no network. So what this people really need is printed information because they don't have access to online sources. A very pushing woman from Havinstadt and also so many other women came together to reach us for more information and we could not even give specific information and we had to coordinate with the Frauenhaus to send them there to seek help, and we felt that that is failure of information. I think that this, with or without Covid-19, is something to be checked on. Germany has laws but their implementation is... I don't know.

Derya: Yes, for sure. It is also what you just said, with or without Corona, these access barriers have been really high, especially for refugee women, but also for women who have economic barriers and have to deal, for example, with the coverage of the abortion as well. You also mentioned the topic of digitalization to make counseling, for example, accessible on online platforms. Would you say that this is for the future a benefit, in terms of access to reproductive health? 

Jane: From my side, I don't know. It can be a benefit if a lot of women can access it. But that makes no sense when everybody is moving and leaving others behind. I think they are the most vulnerable because when you are outside you can choose where to go, which gynecologist you can go to, etc., but for them it is a bit tricky. Some of the women who are in a place called Dubenkirsche, were trying to get information of every type. They were telling us that even the buses had been disconnected. They had to walk for one hour to get to the train station or the nearest center where they could get more information or try to get doctors, and it was of course very tricky. I think if maybe we can keep these women at a place or in a situation where they can access to the digital services, it would be good for everybody to move forward and that would make things easier next time we have a pandemic. 

Stephanie: No, but there is that sense, right? That we are making a leap ahead in terms of digitization, but also catching up maybe on developments that were not forced so much early on. And I think, for me, it is really about opening up options, not replacing personal services which are hugely important for a great many people who need to be sitting opposite somebody to explore their life experiences, to get advice in a way that maybe for them would not happens in the same way if they were on the other end of the phone line, or on the other end of the computer screen. But also for many other people, this might actually make them able to access information services, advice, that they would not seek if it is only available in person. So, it is really just about the options that you have and really putting the experience of people at the center of the planning. To me, this is not just about Covid-19, but about a much broader development and perspective, and a responsiveness to what people actually need, and where and how we can reach them in a way that it is good for them.  

Derya: Talking that this is not only about Covid-19, this is about reproductive health in general, where access has been already fragile, would you say there is any positive developments in the topic of reproductive justice that we can get from this pandemic? Are there any positive aspects that can be used to the benefit of reproductive justice?

Stephanie: At a very general level, I think there is something happening that is interesting. It is that all of us are so much out of our comfort zone with this pandemic, and so we are trying to figure out how to do things, how to get back to some sort of normal life. How to operate around the obstacles that came up, that we haven't had experienced before. Most of us, I imagine, feel that we are sort of coping but perhaps not so very well. But what that does is to show us that is not just about how we personally are dealing with the circumstances, it is just that the whole way that society runs around us or functions with the issue of work. How do we keep working in a way that works for us or for our employers, but also keeps us safe and keeps all the precautions in place? I think many of us are starting to think, well, it is not just me, it is not just my family, all of us are trying to figure this out and that is some sort of systemic thinking. To think, "well, we are struggling here" and that is something that I think we need more of, when it comes to reproductive rights. Because I feel that women and men in Germany are struggling by themselves, mostly, to figure out how to get the access to the information and services they need or how to navigate the health system. If someone does not have a good experience of it, say trying to access an abortion for instance, as an example, or also trying to find a doctor when is a long distance to go, then we might no longer think just as our own experiences but in the view of being in this together. The feeling with Covid-19 is actually the same as with reproductive health services. It is not just me, but all of us are struggling to get access to an abortion, struggling to get access to the information, trying to figure out what to do with this counseling experience which is mandatory, and so on. So maybe it helps us to think more politically about these issues and to say, "wow, is this really good enough or should we maybe do things differently in Germany?" We should ask the questions “why there are so fewer and fewer doctors providing abortions”, why do I have to have counseling even if I already have made up my mind about what I want to do, or spoken to somebody else”. So, those kind of questions may come up not just for individual people but for us collectively, and I think there is a chance there to help us reflect on what we really want and what is important, starting from our own experiences and talk about those collectively.

Jane: Actually, during this Covid-19, I saw in Berlin that there were announcements that even people on the street or even those who do not have a status, should have the right to have access to doctors. And that is very positive because I thought they have seen the repercussion of the whole thing, and that was a very good kick off. I was thinking.... politically, when we check on the globe, Germany was not really hit by this Covid-19 like most of the other countries. Maybe the reason is that they were a bit more prepared in their general health policies. I was thinking that now it is the time to think, "oh, we manage this because we are well prepared, so what if now we guarantee an accessible health cover". If everybody, specially the refugees, would have good accommodation and receive houses with dignity, next time some health issues could be avoided and not get worst. Not only in times of pandemic, but day to day life would be easier for the people and there would be no group that would feel excluded. Some of the women who live on the camps have a work, so they contribute to the economy of this country, and they are all part of this society. That is why it is so important that when it comes to the matter of health justice, especially reproductive justice, policies should be more inclusive.

Stephanie: But there you are picking up a point that I think it is also coming out of this pandemic, which is: who is sitting around the table taking decisions? I think that comes much more to the forefront. We need a diversity of perspectives. We need the affected people being at the table when decisions are taken about the direction that we are all going to take. This has been noted on a few high level occasions, where you just see men or mostly men, but that applies all along from the top to the bottom, of course. That is related with what you are saying, that in order for good decisions to be taken, we need to include everybody who needs to be there basically. 

Derya: Yes, that was actually a topic I wanted to rise here. You, as a representative of the group "Women on Exile", do you feel represented in the discourse on reproductive health in Germany? What is missing maybe? What kind of perspectives are missing in this discourse and on the decision making table?

Jane: We think that we are not really represented because we feel most of the time we are very neutral and there are the groups who fight for the right of abortion. But we see that for us is more neutral because there are those who don’t want to keep their baby, as well as those who do want and we had a lot of cases of pregnant women who went to the hospitals and wanted to keep their babies but sometimes their babies were flashed out without their knowledge and that was really traumatizing. I think we should be in a position to choose, when I want to keep it, I keep it, if not, not. If an abortion wants to be done, it should be without complications or people behind trying to persuade the whole thing. Most of the refugees are getting their kids. In the minds of the authorities, they are getting kids because of the status, but that is not the case. That is the reproductive justice they want to recreate. In two years’ time we went to the south of Germany when the Anka centramal was introduced. We went to one camp in Webengsbot and we met a lot of people staying at separated halls. Both families and people without, all of them. What have divided these walls? We ask, what is the idea of this? Some women inside said that the authorities thought that they were giving birth a lot, and this was a way of limiting them so there was no privacy. This is what is happening to most of the refugees, in most of these camps. There is no privacy. They are denied form their reproductive justice because anybody has a choice what he or she wants with her or his life. We felt that there is no justice when it comes to this situation. There are also people who go to the doctor because they want to alternate their contraceptive method, but they have no choice. Since they are refugees, they only have one option, although it may not be the one that suits that person the best. They have no access to the "morning after" pill. They are just refugees. We see a lot of denied chances in the reproductive health. Also there are the cases of women with fertility problems. They cannot access a Kinderwunsch Zentrum because of the insurance not covering the costs. It is very difficult for them. We have two cases from women who had to go through a lot of bleeding and traumatic experience since the fertility treatment would cost more than just removing their uterus. We have a lot of women now who have no longer uterus because that was their only option and it is very sad.

Derya: Wow, that is very heavy stuff that you are telling us. This shows also how severe the situation is and this is actually not only about someone having some barriers but actually people having their health and right to a dignified life affected. From you point of view and coming from Pro-Familien, if we listen to these experiences and critics, how do you see it?

Stephanie: I think it is important to think of ourselves as complete people. We are not just the women who want to have an abortion or the girl who wants to have sex or the man who loves to have a child with his partner. Many of us have a range of these experiences across our lives. Sometimes we fit the roles that we are supposed to be fulfilling, that society puts on us, we are having children when we are supposed to or we are not having them when we are not supposed to, but, really, we are bigger than that. We are different from that. So I really agree with your point that what we need is choice and an integrated approach to support the way that actually people live their lives. Access to contraception, access to abortion, access to maternity care, access to sexuality education, protection from sexual violence, all of that is part of the story. That is a bit what Corona pandemic brings back to us. We are having these voices pushing their way into the public discourse, saying, "look, sexual violence is going up during these times". We don’t even have to wait for the evidence in terms of police records. We just know what the dynamics of such a situation are. It is our duty to preventative respond to that and find ways of reaching out. The same for contraception and unwanted pregnancies. To just be as close in our work to the way the people live their lives. And to demand the same from politics, really. It is not about ideological approaches. Just the evidence is the way we live our lives. That cannot be denied. The fullness of that cannot be denied. 

Jane: I think also health justice for everybody should not be negotiated. We should no add politics to it because this is one of the basic human rights. So we should not have people negotiating about it. Actually, it should be the fastest thing to be brought to the table and to be very well discussed and quickly implemented, without any negotiation. 

Stephanie: And why we don’t also set up very high standards? We do in so many areas in Germany, setting really high standards and comparing ourselves with the best. The same we should do in reproductive health and rights. What would that mean if we did that? We would be very content with a situation where women have further and further ways to go in order to find a doctor who will provide abortion services. Is that really good enough? The answer has to be no. The answer has to be that we need to look at this very carefully and also learn from other countries. I think that is another thing that is happening during Covid-19. To see how others are dealing creatively with some of the same problems we are facing. For instance, the research that we have on medical abortion by pills and with as few as possible contact points between the service provider and the women, that is something where there is a lot of international experience which we can learn from in Germany, to see how we develop our services here. That could make a huge difference to the way that people with an unwanted pregnancy can deal with that situation. I think that, in that sense, we can also be creative and just look beyond Germany. Drawing also on the experiences of other countries that we may find useful.

Derya: If we take this inspiration that you just said, like getting creative on this topic, what would you say... A lot of people are now thinking that after Corona life is not going to be as before, this pandemic has affected our societies very sustainably, and that also goes for reproductive health. So if we try to think it in a more visionary way, what should change in terms of better access to reproductive health? If we take it now in our hands, if we become creative, if we formulate demands to political decision makers, what are the concrete steps that should be taken, from your point of view?

Stephanie: Jane you said that things were not exactly great before Corona either. So I think, that is a thing we need to keep in mind. We don't really necessarily want to go back to the way things were. We want to go somewhere else entirely. So, for me that is quite heartening because I find it useful to think "What do we actually want? How do we actually want to do things?" As Pro-Famillien, we started as you were saying, from a vision of sexual reproductive rights. We started from people's experiences of their rights, and that means with the fullness of their needs and desires. We would still be looking at the obstacles to access to information and services, but we shouldn’t just get busy trying to get rid of them. We would maybe also start thinking at the other end and think, what do we actually want to see? How in an ideal world would everybody be able to live their sexuality and their reproductive lives? And then, this notion of having a choice and being who you want to be at different points in your life. And being safe, whichever way you define that. And fulfilled. That would be what leads us. From that perspective, it makes no sense that there is no health care coverage for contraception. I mean, everybody should have the option, independently of how much they earn and where they live, to access contraception. That is basic to reproductive choice. That would be right in the middle there. One of the things that we are focused on. 

Jane: Actually, when we were thinking about this pandemic and we thought, yes, things like what we said were not good before, and they are not going to be better, even we don’t want them to be the same again. We want to have a new life. We were thinking, now it is not only the refugees who are affected. It is affecting the whole society and now it is not about us only. Then, from this point, what can we do together? And this, I think, is a hard time, nobody has proven that we are not on risk and we are one. Specially in Germany, we have gone through the lock down, we have seen it, people have lost jobs, so much has happened. Our question was: what can we do? Where can we join in this society? It's like persuading people, please, vote the best people who make policies, because I think when it comes to the whole thing, it depends on those who are discussing about this matters, who are passing the motions and who are doing it. I think, when we have the right people who are making the decisions, we will really have a change in the society. Then, we have seen that even doctors were affected. Everybody was really affected. It is a high time for us to act together. For the activists, and the groups, and the movements, to come together and start here from the drawing board. Moving together and making sure that there are people, like maybe the Pro-Familien, and when we walk really close together, we feel they have a chance to push it even more far to the Gesundheit Frauen and Gesundheit Ministry. We see that this is the high time to breach as groups. This is the high time to come together without any barriers and to see, from this point, how do we go on. How we will brake these barriers as a society. This is the high time to come together, I don't know how but it is the right time. Covid-19 maybe was only here to show people that this is the time to start acting together and moving forward as one.

Derya: It has already worked now. We are at this table together and I am sure there is other digital and real tables that we will meet and discuss, like these visions. And then you said, from the drawing board, like from scratch maybe again, of course building on positive movements and continuities, but think together what alliances do we need and what are our ideas for a better reproductive justice. I think we are already over time but I really want to thank you for your participation. I see this more as a starting point, as you already said, to have more discussions and cooperation.