IPPF - Menstrual Regulation or Erratic Regulation?

We know that the $6 million DFATD gave IPPF for the Maternal, newborn and child health initiative wasn't to be used for abortion or menstrual regulation services.

(Note that MR is an abortion only if the woman is pregnant; so not all MR's amount to abortions. Because they don't check whether the woman is pregnant first, laws that ban abortions can be circumvented, since they don't actually know that she is pregnant. But if she is pregnant, then MR is an abortion.)

We also know Canadians are forced to simply take IPPF's word that this money is not being used for abortion or menstrual regulation services. See here and here. That's because IPPF says they aren't using the funding for abortion services, but there is no third party corroboration of this fact.

My latest ATIP to DFATD has again raised the MR question. This time the evidence is even more questionable.

On June 9, 2014, IPPF sent a report to DFATD detailing the services it provided in the five countries. Under the heading GYNECOLOGY - MANAGEMENT - MEDICAL, was the following line item:

"Gynecology - Management - Medical -Menstrual Regulation 9,800 [services]"

It seems that DFATD asked to IPPF to clarify this. There were a few emails from IPPF on this, and finally we get IPPF's conclusion of their investigation.

"Dear Anne, 

Per [name blacked out] previous email, attached I am sending you a revised table (originally submitted on 9 June 2014) showing the breakdown of 2013 gynaecological service data. With this email, I re-confirm that all the services that have been previously reported have been undertaken with funding from the DFATD project. The only revision has been that the services previously reported as `Menstrual Regulation' are now reported under `Erratic Regulation'. (emphasis added)

After consulting back with each of the MAs that had initially reported services under `Menstrual Regulation' we found that these have been miscategorised and no menstrual regulation services had in fact been offered. The MAs in Afghanistan and Sudan, who had originally reported' menstrual regulation services in 2013, had actually provided `Erratic regulation' (i.e. of menstruation) services. The IPPF service statistics module definition for the `Erratic regulation' service is: `A trained service provider provides management for menstrual irregularities such as heavy or painful periods with medication (such as oestrogens) when this is not contraindicated, for clients experiencing abnormally heavy or irregular periods, in a space which allows confidentiality.'  (emphasis added)

These services have now been correctly re-categorised. There are therefore no menstrual regulation services recorded for any of the 5 MAs in the DFATD project and the revised table with the breakdown of 2013's gynaecological services now displays the correct category. 

I am happy to go over this information with you over the phone if it would be helpful. 

With Warm Regards,

[name blacked out]"

So I looked up "erratic regulation", first on IPPF's site. No such definition exists there. Then I Googled "erratic regulation". I did find some definitions, but none of them relate to a anything gynecological and I could find nothing to indicate that this is a bona fide gynecological treatment.

As expected, Menstrual regulation was on IPPF's website:

"Evacuation of the uterus of a woman who has missed her menstrual period by 14 days or fewer, who previously had regular periods and who has been at risk of conception. In some countries menstrual regulation is legal, even though therapeutic abortion is not."

The corrected document IPPF sent to DFATD reads:

"Gynecology - Management - Medical - Erratic Regulation 9,800 [services]"  

So what exactly is going on here?
---------------------------------------------------------------------------------------------------------
Letter from IPPF to DFATD:

 Original submission from IPPF to DFATD

 Corrected submission from IPPF to DFATD:

If A=B and B=C, does A=C?

So PPFA sells fetal body parts.

PPFA is part of IPPF.

And IPPF gets tax dollars from Canada.

I don't think I like this relationship.

IPPF: 45 million services, but no abortion?

You may recall that the $6 million funding Canada gave to IPPF through DFATD for Afghanistan, Bangladesh, Mali, Sudan and Tanzania, was not to go for abortion services.

In fact, in the ATIP document I received from DFATD, there are multiple assurances from IPPF that the money is not being used for abortion services.Yet all we really have is IPPF's word for it.

Below I have summarized all the services provided by IPPF in fiscal year 2013/2014.

As you can see, that's a lot of services, yet many are not at all well defined.

So I asked for some clarifications on some of these services.

For item 1128 (Provide other SRH medical services) which had 1,798,317 services, I asked for a further breakdown of what these services were.

DFATD response:

"Consultation - Bangladesh, Mali
Diagnostic tests - Bangladesh, Mali,Tanzania
Therapy/treatment - Bangladesh, Afghanistan
Surgery - Bangladesh, Tanzania
Other - Bangladesh, Tanzania, Sudan"

As you can see these breakdowns still don't tell us what kinds of services IPPF is providing. So I asked for an additional clarification.

DFATD response:

"IPPF does not have additional description for these services, but it should be noted that these services do not relate to HIV, STI, abortion, gynaecology, obstetrics, etc."

So IPPF has no idea what exactly, these almost 2 million services include--yet we are simply expected to take IPPF's word for it that they don't include abortion?

Then for item 1211 (Other family planning services for young people), of which there were 4,860,975 services, I asked for a description of each of these "family planning services" and their breakdown by numbers, for each different category of service.

DFATD response:

"All family planning services are provided to young people. Essentially the same methods as the other FP indicators, for clients under 25. No information about how DFATD funding relates to this."

I then asked DFATD, if IPPF is saying that they do not know how much DFATD money goes to giving FP services to young people?

DFATD's response:

"IPPF does not price consultations or staff member’s time - by either age group or service category, therefore they cannot earmark a specific amount for what was spent on youth family planning services. IPPF estimates the cash value based on salaries and clinic space as they are the two key drivers of price."

So IPPF provided almost 5 million services to young people, with no further breakdown. Again we just have to take IPPF's word for it. And what is the ages of these young people?

DFATD's response:

"Member Associations (IPPF's local partners) abide by the legal limits in the country it operates."

And what are the legal age limits in these countries? I'm waiting for an answer to that.

But there in a nutshell, is the real problem with all this. The Canadian people give their tax dollars to DFATD. DFATD then gives that money to IPPF. IPPF then gives that money to its "member associations" to provide in most cases--undefined services.

If IPPF can't break down these services any further (and they can't), then how do they know the member associations are not using the money for abortion? Do we just have to take their word for it? Apparently.

DFATD and IPPF - purchased and provided are different

More on my DFATD ATIP for the $6 million funding to International Planned Parenthood.

Suzanne asked who is using all this contraception, and wondered about the 15000 IUDs? So I decided to review the numbers to find out.

Below are the list of "Commodities and Clinical Consumables" (purchases) and the "Data Table" report (provided). Both reports are for the year 1 April 2013 to 31 March 2014. The numbers are different.

This is what was purchased:
IUDs listed under "Commodities and Clinical Consumables":
Afghanistan: 15,000
Bangladesh: 0
Mali: 2,500
Sudan: 0
Tanzania: 0
Total: 17,250

And this is what was provided:
IUDs listed under "Data Table":
Afghanistan: 11,299
Bangladesh: 4,221
Mali: 1,366
Sudan: 1,104
Tanzania: 1,671
Total: 19,661

----------------
This is what was purchased:
Condoms listed under "Commodities and Clinical Consumables":
Afghanistan: 290,000
Bangladesh: 0
Mali: 1,132,587
Sudan: 0
Tanzania: 0
Total: 1,447,787

And this is what was provided:
Condoms listed under "Data Table":
Afghanistan: 22,370
Bangladesh: 530,452
Mali: 224,588
Sudan: 1,653
Tanzania: 92,007
Total: 871,070 (the total on the Data Table report actually says 868,241)

These two tables are the "Data Tables" from the report

DFATD and IPPF - check your numbers

More on my DFATD ATIP for the $6 million funding to International Planned Parenthood.

I received a list of commodities and clinical consumables for the period 1 April 2013 - March 2014 (12 month period), which included contraception, injectables, condoms, spermicides etc. I also received the same information for the previous semi-annual report for April -September 2013 (a six month period).

I decided to compare the two reports to see how the numbers had increased, since the first was for a full year and the latter for only six months. When I looked a bit closer at the two reports, I noticed something. The numbers on both reports for Afghanistan and Sudan were identical (below I reproduce the first page of Afghanistan's).

No commodities were purchased between October 2013 and March 2014 (since the numbers are identical). Maybe all items were purchased at the beginning of the year? I don't know.

In any event, how many contraceptives and emergency contraceptives are we buying in Afghanistan anyway? See charts below.

(NOTE: Postinor-2 is emergency contraception. EC is considered an abortifacient if the egg has already been fertilized (i.e it prevents implantation in the uterus, killing the embryo). Abortion is illegal in Afghanistan.)

DFATD and IPPF - 45,118 people not sterilized in Tanzania

I've finally received the results of my most recent ATIP to DFATD regarding the $6 million funding to International Planned Parenthood. 

This one asked for information since my last ATIP, in particular, for IPPF's Annual Report for 1 April 2013 - March 2014.

I have learned a couple of interesting things this time, and will post them over the next little while.

The first thing I learned is that the people of Tanzania may not be as enthralled with being sterilized as IPPF would like them to be.

On page 143 of the ATIP, from the Annual Report, on line item 1121 Provide sterilization services in Afghanistan, Bangladesh, Mali, Sudan and Tanzania note this:

The target sterilizations for the year is 63,455 sterilizations, but the actual is only 18,337 sterilizations. That's 45,118 people under target.

Under the comments section is this:

"The overall shortfall is almost entirely due to Tanzania. It has not been possible to ascertain why."

Could it be that the people of Tanzania don't want to be sterilized? Maybe they don't like having IPPF suggesting they should be sterilized. 

Canada pays for emergency contraception and abortion care in Afghanistan

Elizabeth Payne reported in today's Ottawa Citizen on my posting that revealed that CIDA/DFATD is funding emergency contraception in Afghanistan through IPPF.

What she didn't say, is that my ATIP also revealed that we are funding "safe abortion care".

The first thing that's worrisome about the Citizen article, is that NDP international development critic  Hélène Laverdière thinks that the emergency contraception used (Postinor-2) is not abortion.

“It’s not abortion, it is contraception". 

In fact the information provided by the manufacturer says that:

"Postinor-2 is not intended as a regular method of contraception." 

That's because, emergency contraception is an abortifacient if the egg has already been fertilized (i.e it prevents implantation in the uterus, killing the embryo). Wishful thinking, doesn't make it true.

Then Ms. Laverdière says:

"I don’t see why if it is a choice for Canadian women, it cannot be a choice offered to Afghan women.”

Now this is really out there. Shouldn't Ms. Laverdière, in her role as international development critic, know that abortion (including emergency contraception) is illegal in Afghanistan?

As I noted in that blog posting, the Population Research Institute says that:

"The current Afghanistan abortion law mandates a seven-year prison term and a monetary fine for each abortion performed. The only exception requires the written opinion of physicians, and a judicial review. According to strict and clear guidelines promulgated by the Ministry of Justice, this same law would apply to anyone who has prescribed “morning-after pills” or “emergency contraception” in Afghanistan, or even to anyone carrying these devices in the country."

And finally this from DFATD in the Citizen article:

"Foreign Affairs spokeswoman Amy Mills, quoting the World Health Organization. “WHO confirms that: ‘Levonorgestrel emergency contraceptive pills are not effective once the process of implantation has begun, and they will not cause abortion,’ ” she wrote in an email, adding, “DFATD funds are not used to fund abortion.”

I beg to differ. Canada is funding emergency contraception and abortion care in Afghanistan.

Abortion by any other name...

MP questions CIDA due diligence insuring IPPF isn't funding abortions

We now have more cause for concern regarding CIDA/DFATD's $6 million funding of IPPF.

In an ATIP to DFATD I asked for correspondence regarding the Muskoka initiative on maternal and child health.to the PMO and CIDA.

This yielded a few letters, but one in particular was noteworthy.

On October 27, 2011, in a very detailed letter from MP Maurice Vellacott to Stephen Harper, Mr. Vellacott voices his concerns to the Prime Minister by asking seven questions about the $6 million funding IPPF received as part of the Muskoka initiative. (see below for Mr. Vellacott's letter and the responses from Mr. Harper and Ms. Oda).

In a nutshell, Mr. Vellacott's questions what due diligence is in place to ensure the funding would not go to pay for any abortion services, as was stipulated by the contribution agreement between CIDA and IPPF. All pertinent questions I thought, some of which I've also asked myself to CIDA/DFATD. (For all my links to the CIDA/IPPF funding see this page.)

The Prime Minister doesn't answer any of Mr. Vellacott's questions. Not one. And then the PM simply forwards Mr. Vellacott's letter on, to then Minister Bev Oda, who also doesn't answer any of his questions. Not one. In fact Ms. Oda's reply is obviously a form letter, since it is exactly the same as all of her responses to the other letters in the package.

So why were Mr. Vellacott's questions never answered?

Canadian money to IPPF for funding "safe abortion care" and "emergency contraception" in Afghanistan

Despite assurances by the Federal government that no Canadian money given to IPPF would go towards abortion, my latest ATIP to CIDA/DFATD revealed that IPPF is buying "emergency contraception" (34,000 units of the Abbot drug Postinor -2 (Levonorgestrel)). They are also providing "safe abortion care" in Afghanistan.

As we know, "emergency contraception" is taken after sexual intercourse for the purpose of "preventing" pregnancy, but it functions as an abortifacient if fertilization has already occurred (it prevents implantation of the embryo, thus destroying the life of the newly conceived human being.)

(See below for page 30 from the IPPF Annual Report Year 2 (1 April 2012 - 31 March 2013) and page 88 from the IPPF Midyear Report (1 April to 30 September 2013).

In fact, according to this medical leaflet, Postinor-2 is only used as emergency contraception:

"Postinor-2 is an emergency contraceptive only. Postinor-2 is not intended as a regular method of contraception. It is used to prevent pregnancy when taken within 72 hours of unprotected intercourse. It is estimated that Postinor-2 will prevent 85% of expected pregnancies. 95% of expected pregnancies will be prevented if taken within the first 24 hours, declining to 58% if taken between 48 hours and 72 hours after unprotected intercourse."

Not only that. Apparently AFGA's abortion services "needs improvement." (Afghan Family Guidance Association is an associate member of International Planned Parenthood Federation (IPPF) and receives funding from IPPF).

Why is AFGA providing abortion care, when we aren't even supposed to be funding abortion services in these countries?

This is what the Population Research Institute says about the legality of abortion, and emergency contraception in Afghanistan:

"The current Afghanistan abortion law mandates a seven-year prison term and a monetary fine for each abortion performed. The only exception requires the written opinion of physicians, and a judicial review. According to strict and clear guidelines promulgated by the Ministry of Justice, this same law would apply to anyone who has prescribed “morning-after pills” or “emergency contraception” in Afghanistan, or even to anyone carrying these devices in the country."

IPPF states in their annual report that this funding is directed towards:

"women, girls, men and boys who need access to reproductive health services and information. Clients reached throughout this project are female, male, young and old, couples and families in five countries (Afghanistan, Bangladesh, Mali, Sudan and Tanzania). The project prioritizes vulnerable individuals and groups, and also young people, especially young women. Seventy per cent of all the clients served through the project are poor, marginalized, socially excluded and/or underserved, while 33% of all clients are young people, aged between 15-25 years."

Are these poor, marginalized and vulnerable young women, even told what emergency contraceptive is? That it doesn't necessarily prevent conception--i.e. that if fertilization (conception) has occurred, it destroys that newly conceived life by preventing implantation. In other words, are these poor, marginalized and vulnerable clients giving their informed consent?

By all accounts, this is a pretty clear indication to me, that we are providing abortion services in Afghanistan. Abortion services that are specifically excluded from the terms and conditions of the $6 million dollar grant we gave to IPPF.

This should cause us grave concern.

IMPLANON in Sudan: tip of the iceberg?

My latest ATIP to CIDA/DFATD reveals that the contraceptive IMPLANON is being purchased and administered in Sudan by IPPF.

I thought I'd have a look at the risks and other issues associated with the implant.

They are all listed below. I thought I'd just point out a few of them from the Merck publication of the FDA-Approved Patient Labeling:

"It is not known if IMPLANON is as effective in very overweight women because studies did not include many overweight women."

Are overweight women in Sudan told this?

"Serious Blood Clots: IMPLANON may increase your chance of serious blood clots, especially if you have other risk factors such as smoking. It is possible to die from a problem caused by a blood clot, such as a heart attack or a stroke."

Are women in Sudan told about this, and other serious risks?

"Breast Cancer: It is not known whether IMPLANON use changes a woman’s risk for breast cancer."

They don't know the risk of breast cancer? Then why is IMPLANON being used at all?

"This is not a complete list of possible side effects." 

You mean there's more side effects? What are they?

And the document is replete with advice to call your health care provider for more information? Would that be IPPF? Does IPPF have doctors to answer these women's questions?

Finally, is the 11 page list of risks, interactions with other medications, side effects, etopic pregnancy risks, etc.--explained fully to the woman? Is she given a copy of this brochure in her own language? Can she even read it? (literacy rate in Sudan is 27%) What about informed consent?

Lots of questions. Not many answers. This is poor women's lives we are risking with Canadian money. Is that what being a Canadian is all about?

And I haven't even talked about the other drugs we are buying for the five countries (Afghanistan, Mali, Tanzania, Bangladash and Sudan).
-----------------------------------------------------------------------------------------------------------

(IMPLANON from the manufacturer MERCK)

FDA-Approved Patient Labeling

IMPLANON® (etonogestrel implant)

Subdermal Use

IMPLANON® does not protect against HIV infection (the virus that causes AIDS) or other

sexually transmitted diseases. Read this Patient Information leaflet carefully before you

decide if IMPLANON is right for you. This information does not take the place of talking with

your healthcare provider. If you have any questions about IMPLANON, ask your healthcare

provider.

What is IMPLANON?

IMPLANON is a hormone-releasing birth control implant for use by women to prevent pregnancy

for up to 3 years. The implant is a flexible plastic rod about the size of a matchstick that contains

a progestin hormone called etonogestrel. Your healthcare provider will insert the implant just

under the skin of the inner side of your upper arm. You can use a single IMPLANON implant for

up to 3 years. IMPLANON does not contain estrogen.

What if I need birth control for more than 3 years?

The IMPLANON implant must be removed after 3 years. Your healthcare provider can insert a

new implant under your skin after taking out the old one if you choose to continue using

IMPLANON for birth control.

What if I change my mind about birth control and want to stop using IMPLANON before 3

years?

Your healthcare provider can remove the implant at any time. You may become pregnant as

early as the first week after removal of the implant. If you do not want to get pregnant after your

healthcare provider removes the IMPLANON implant, you should start another birth control

method right away.

How does IMPLANON work?

IMPLANON prevents pregnancy in several ways. The most important way is by stopping the

release of an egg from your ovary. IMPLANON also thickens the mucus in your cervix and this

change may keep sperm from reaching the egg. IMPLANON also changes the lining of your

uterus.

How well does IMPLANON work?

When the IMPLANON implant is placed correctly, your chance of getting pregnant is very low

(less than 1 pregnancy per 100 women who use IMPLANON for 1 year). It is not known if

IMPLANON is as effective in very overweight women because studies did not include many

overweight women.

Who should not use IMPLANON?

Do not use IMPLANON if you

• Are pregnant or think you may be pregnant

• Have, or have had serious blood clots, such as blood clots in your legs (deep venous

thrombosis), lungs (pulmonary embolism), eyes (total or partial blindness), heart (heart

attack), or brain (stroke)

• Have liver disease or a liver tumor

• Have unexplained vaginal bleeding

• Have breast cancer or any other cancer that is sensitive to progestin (a female

hormone), now or in the past

• Are allergic to anything in IMPLANON

Tell your healthcare provider if you have or have had any of the conditions listed above. Your

healthcare provider can suggest a different method of birth control.

In addition, talk to your healthcare provider about using IMPLANON if you:

• Have diabetes

• Have high cholesterol or triglycerides

• Have headaches

• Have gallbladder or kidney problems

• Have a history of depressed mood

• Have high blood pressure

• Have an allergy to numbing medicines (anesthetics) or medicines used to clean your

skin (antiseptics). These medicines will be used when the implant is placed into or

removed from your arm.

Interaction with Other Medicines

Tell your healthcare provider about all the medicines you take, including prescription and non-prescription medicines, vitamins and herbal supplements. Certain medicines may make

IMPLANON less effective, including:

• barbiturates

• bosentan

• carbamazepine

• felbamate

• griseofulvin

• oxcarbazepine

• phenytoin

• rifampin

• St. John's wort

• topiramate

• HIV medicines

Ask your healthcare provider if you are not sure if your medicine is one listed above.

If there are medicines that you have been taking for a long time, that make IMPLANON less

effective, tell your healthcare provider. Your healthcare provider may remove the IMPLANON

implant and recommend a birth control method that can be used effectively with these

medicines.

When you are using IMPLANON, tell all of your healthcare providers that you have IMPLANON

in place in your arm.

How is the IMPLANON implant placed and removed?

Your healthcare provider will place and remove the IMPLANON implant in a minor surgical

procedure in his or her office. The implant is placed just under the skin on the inner side of your

upper arm.

The timing of insertion is important. Your healthcare provider may:

• Perform a pregnancy test before inserting IMPLANON

• Schedule the insertion at a specific time of your menstrual cycle (for example, within the

first days of your regular menstrual bleeding)

Immediately after the IMPLANON implant has been placed, you and your healthcare

provider should check that the implant is in your arm by feeling for it.

If you and your healthcare provider cannot feel the IMPLANON implant, use a nonhormonal

birth control method (such as condoms) until your healthcare provider

confirms that the implant is in place. You may need special tests to check that the implant is

in place or to help find the implant when it is time to take it out.

Your healthcare provider will cover the site where IMPLANON was placed with 2 bandages.

Leave the top bandage on for 24 hours. Keep the smaller bandage clean, dry, and in place for 3

to 5 days.

You will be asked to review and sign a consent form prior to inserting the IMPLANON implant.

You will also get a USER CARD to keep at home with your health records. Your healthcare

provider will fill out the USER CARD with the date the implant was inserted and the date the

implant is to be removed. Keep track of the date the implant is to be removed. Schedule an

appointment with your healthcare provider to remove the implant on or before the removal date.

Be sure to have checkups as advised by your healthcare provider.

What are the most common side effects I can expect while using IMPLANON?

• Changes in Menstrual Bleeding Patterns (menstrual periods)

The most common side effect of IMPLANON is a change in your normal menstrual bleeding

pattern. In studies, about one out of ten women stopped using the implant because of an

unfavorable change in their bleeding pattern. You may experience longer or shorter bleeding

during your periods or have no bleeding at all. The time between periods may vary, and in

between periods you may also have spotting.

Talk with your healthcare provider right away if:

• You think you may be pregnant

• Your menstrual bleeding is heavy and prolonged

Besides changes in menstrual bleeding patterns, other frequent side effects that caused women

to stop using the implant include:

• Mood swings

• Weight gain

• Headache

• Acne

• Depressed mood

Other common side effects include:

• Headache

• Vaginitis (inflammation of the vagina)

• Weight gain

• Acne

• Breast pain

• Viral infections such as sore throats or flu-like symptoms

• Stomach pain

• Painful periods

• Mood swings, nervousness, or depressed mood

• Back pain

• Nausea

• Dizziness

• Pain

• Pain at the site of insertion

This is not a complete list of possible side effects. For more information, ask your healthcare

provider for advice about any side effects that concern you. You may report side effects to the

FDA at 1-800-FDA-1088.

What are the possible risks of using IMPLANON?

• Problems with Insertion and Removal

The implant may not be placed in your arm at all due to a failed insertion or if the implant

has fallen out of the needle. If this happens, you may become pregnant. Immediately

after insertion, and with help from your healthcare provider, you should be able to feel

the implant under your skin. If you can’t feel the implant, tell your healthcare provider.

Removal of the implant may be very difficult or impossible because the implant is not

where it should be. Special procedures, including surgery in the hospital, may be needed

to remove the implant. If the implant is not removed, then the effects of IMPLANON will

continue for a longer period of time.

Other problems related to insertion and removal are:

• Pain, irritation, swelling, or bruising at the insertion site

• Scarring, including a thick scar called a keloid around the insertion site

• Infection

• Scar tissue may form around the implant making it difficult to remove

• The implant may come out by itself. You may become pregnant if the implant

comes out by itself. Use a back up birth control method and call your healthcare

provider right away if the implant comes out.

• The need for surgery in the hospital to remove the implant

• Injury to nerves or blood vessels in your arm

• The implant breaks making removal difficult

• Ectopic Pregnancy

If you become pregnant while using IMPLANON, you have a slightly higher chance that

the pregnancy will be ectopic (occurring outside the womb) than do women who do not

use birth control. Unusual vaginal bleeding or lower stomach (abdominal) pain may be a

sign of ectopic pregnancy. Ectopic pregnancy is a medical emergency that often requires

surgery. Ectopic pregnancies can cause serious internal bleeding, infertility, and even

death. Call your healthcare provider right away if you think you are pregnant or have

unexplained lower stomach (abdominal) pain.

• Ovarian Cysts

Cysts may develop on the ovaries and usually go away without treatment but sometimes

surgery is needed to remove them.

• Breast Cancer

It is not known whether IMPLANON use changes a woman’s risk for breast cancer. If you

have breast cancer now, or have had it in the past, do not use IMPLANON because

some breast cancers are sensitive to hormones.

• Serious Blood Clots

IMPLANON may increase your chance of serious blood clots, especially if you have

other risk factors such as smoking. It is possible to die from a problem caused by a blood

clot, such as a heart attack or a stroke.

Some examples of serious blood clots are blood clots in the:

• Legs (deep vein thrombosis)

• Lung (pulmonary embolism)

• Brain (stroke)

• Heart (heart attack)

• Eyes (total or partial blindness)

The risk of serious blood clots is increased in women who smoke. If you smoke and want

to use IMPLANON, you should quit. Your healthcare provider may be able to help.

Tell your healthcare provider at least 4 weeks before if you are going to have surgery or

will need to be on bed rest. You have an increased chance of getting blood clots during

surgery or bed rest.

• Other Risks

A few women who use birth control that contains hormones may get:

• High blood pressure

• Gallbladder problems

• Rare cancerous or noncancerous liver tumors

• Broken or Bent Implant

If the implant breaks or bends while in your arm, how the implant works should not be

affected. If you have questions contact your healthcare provider.

When should I call my healthcare provider?

Call your healthcare provider right away if you have:

• Pain in your lower leg that does not go away

• Severe chest pain or heaviness in the chest

• Sudden shortness of breath, sharp chest pain, or coughing blood

• Symptoms of a severe allergic reaction, such as swollen face, tongue or pharynx;

trouble swallowing; or hives and trouble breathing

• Sudden severe headache unlike your usual headaches

• Weakness or numbness in your arm, leg, or trouble speaking

• Sudden partial or complete blindness

• Yellowing of your skin or whites of your eyes, especially with fever, tiredness, loss of

appetite, dark colored urine, or light colored bowel movements

• Severe pain, swelling, or tenderness in the lower stomach (abdomen)

• Lump in your breast

• Problems sleeping, lack of energy, tiredness, or you feel very sad

• Heavy menstrual bleeding

What if I become pregnant while using IMPLANON?

You should see your healthcare provider right away if you think that you may be pregnant. It is

important to remove the implant and make sure that the pregnancy is not ectopic (occurring

outside the womb). Based on experience with other hormonal contraceptives, IMPLANON is not

likely to cause birth defects.

Can I use IMPLANON when I am breastfeeding?

If you are breastfeeding your child, you may use IMPLANON if 4 weeks have passed since you

had your baby. A small amount of the hormone contained in IMPLANON passes into your

breast milk. The health of breast-fed children whose mothers were using the implant has been

studied up to 3 years of age in a small number of children. No effects on the growth and

development of the children were seen. If you are breastfeeding and want to use IMPLANON,

talk with your healthcare provider for more information.

PMO: Engaging citizens fosters trust

When Stephen Harper told us that Canada will host a summit on saving the lives of vulnerable women and children, I thought, good idea.

What would the obvious next question be that immediately springs to mind: Who will be attending the summit?

In other words, who are the "Canadian stakeholders, experts" and "global leaders from developed and developing countries, international organizations, civil society, the private sector, and foundations to take stock of the progress made to date and discuss the way forward" mentioned in the press release?

So I asked the Prime Minister's office this question. And in the interest of transparency--as I assume the summit will be funded by taxpayers--I thought I'd get some kind of substantive answer from the PMO.

What I was told was that:

"The list of participants of the summit will be made available in due course—all of the latest information will be updated immediately to www.pm.gc.ca  where you can access it."

Which prompted me to ask two more questions:

1) I'd also like to obtain information on the process that is being used for selecting invitees. How is that being accomplished? And what is the criteria for choosing an organization?

2) Also, what if I'd like to submit a name of an organization to be included in the summit? How can I go about doing that?

After a couple of more emails and phone calls to the PMO, I finally received my response from Carl Vallée. Short and sweet:

"We don't discuss internal process."

Don't we, as Canadian Citizens have a right to know who is being invited to discuss something as important as this summit obviously will be? After all, it is our money that will be funding the summit itself, never mind the actual aid to this initiative: a total of $7.3 billion from G8 and non-G8 countries, which includes Canada.

I think my questions are completely fair and reasonable and deserve an answer. In fact why would the PMO even tell us about this initiative, if they have no intention of answering questions about it, or giving us any additional information?

What about openness and transparency?

So how much has CIDA given IPPF anyway?

This is another fun fact from my recent ATIP to CIDA/DFATD.

The answer would be $147 million since 1983. That's about $5 million a year.

That's your tax dollars and mine. Given to the world's number one abortion provider.

Jadelle not purchased for Tanzania - instead purchased for Mali

Remember Jadelle? Well it's back.

I recently received more information from CIDA/DFATD about the $6 million funding to IPPF.

In my current ATIP, it looks like my writing about Jadelle before (see page 181 below) triggered some questions from DFATD to IPPF, about Jadelle.

DFATD asked IPPF:

"Could you please provide us with more information on the contraceptives that your Tanzanian member uses as part of the project we fund?

The response (in part) from IPPF was that:

1. IPPF has not purchased Jadelle and distributed it to Tanzania
2. UMATI has not purchased Jadelle with Canadian funds
3. Canadian funds have not been used to ensure service providers and insert and remove Jadelle [sic] (see page 178 below)

Interesting. But what is even more interesting is that on another page located withing the semi-annual report, I discovered that Jadelle was purchased and used in Mali.

In the IPPF semi-annual report (April-September 2013) it was revealed that IPPF purchased a quantity of 4,000 Jadelle implants for Mali. On the same report, sure enough there is no Jadelle listed for Tanzania. (I'll post those pages later.)

(Update April 25, 2014, More information on this drug here
"Adverse health conditions among American women subsequent to Norplant use American women have experienced serious adverse health conditions after having Norplant inserted, including, but not limited to, increased intracranial fluid pressure (pseudo tumor cerebri), chronic blurred vision, leading to permanent vision loss or blindness, and tumors in the brain and other organs.2,3 Other conditions experienced by American women include hyper menorrhea (heavy and sustained menstrual bleeding), serious acne, sustained nausea, debilitating headaches, weakness or paralysis in one or more limbs, endometriosis, ovarian cysts, weight gains of sometimes over 100 pounds, severe mood swings and irritability. Further, many have found that having Norplant removed was a much more difficult procedure than they had been originally advised.4")

Note: On my last CIDA/DFATD ATIP, I had questioned them to find out specifically what was being funded under the "Approved Activities" (1) for the five countries Afghanistan, Mali, Tanzania, Bangladesh and Sudan. I was told that "no records related to your request exist." This time I received some of the details of that request. I'll blog more about that later.

CIDA funding to IPPF - the series

Here are all my writings on the funding CIDA (now called DFATD or Foreign Affairs, Trade and Development Canada) has given to IPPF (International Planned Parenthood).

Monday, July 20, 2015
IPPF - Menstrual Regulation or Erratic Regulation?

Monday, February 16, 2015
IPPF and Depo-Provera: what about informed consent?

IPPF: 45 million services, but no abortion?
Friday, December 12, 2014

Government of Bangladesh dismisses board of FPAB
Tuesday, October 7, 2014

DFATD and IPPF - the numbers don't add up
September 23, 2014

DFATD and IPPF - check your numbers
September 22, 2014

DFATD and IPPF - 45,118 people not sterilized in Tanzania
September 22, 2014

---------------------------------------------------------------------------------
MP questions CIDA due diligence insuring IPPF isn't funding abortions

May 4, 2014

Canadian money to IPPF for funding "safe abortion care" and "emergency contraception" in Afghanistan
May 2, 2014

IMPLANON in Sudan: tip of the iceberg?
April 15, 2014

So how much has CIDA given IPPF anyway?
March 31, 2014

Jadelle not purchased for Tanzania - instead purchased for Mali
March 30, 2014

CIDA does IPPF site visits in only two of five countries

Dec 10, 2013, 2013 

What's going on in Bangladesh?

Oct 15, 2013 

CIDA and IPPF and abortion - Fact Sheets

Oct 04, 2013 

CIDA - when due diligence isn't diligent

Sep 28, 2013

What's not good enough for us is good enough for Tanzania

Sep 14, 2013

Run With Life: ATIP: CIDA and IPPF (Part 4)

Jan 23, 2012

ATIP: CIDA and IPPF (Part 3)

Jan 23, 2012 

ATIP: CIDA and IPPF (Part 2)

Jan 23, 2012 

Run With Life: ATIP: CIDA and IPPF (more to come...)

Jan 21, 2012

CIDA does IPPF site visits in only two of five countries

It seems DFAIT's (formerly CIDA) due diligence criteria of making field visits to ensure that the $6 million funding to IPPF does not include abortion services, didn't happen in three of the five countries involved.

This latest ATIP request to DFAIT was based on an email I had received previously from a CIDA media person that stated:

"Field visits to projects and regular monitoring by CIDA field representatives also provide key information that permits CIDA to determine and assess whether the implementing organization is performing or delivering services in accordance with the terms and conditions of the funding agreement."

So I asked for:

"all information regarding these field visits to the five countries benefiting from the $6 million funding to IPPF."

This is what I received.

There were site visits to Bangladesh between February 12, 2012 and Feb 23, 2012.

And this note:

"All partners were very pleased to have a CIDA officer visit. Some have been receiving funding for several years but have never had the opportunity to welcome a CIDA officer."

Sounds like this is the first time CIDA had done any checking as to how our funds are being used in Bangladesh in several years.

We know that FPAB [IPPF's member association in Bangladesh] does menstrual regulation in Bangladesh, but supposedly no Canadian funds are being used for this. But then we read this comment in the report under their "advocacy program":

"...the management team indicated that FPAB does a lot of advocacy work. Advocacy is part of everything they do, either at the policy making level through activities targeting the MoHFW (Ministry of Health and Family Welfare) or at the district and grassroots levels, whenever there is an opportunity during formal meetings with local authorities and religious leaders at training sessions etc. They envision this staying the same over the next few years."

Would that mean then, advocacy for menstrual regulation and abortions? One would assume so, since it is a well known fact that IPPF wants to make abortion legal everywhere and never shies away from telling us so.

The "background" portion of the information does make one reference that abortion services will not be funded under the initiative.

Pages 76 and 77 identify a site visit to Tanzania, but it says virtually nothing about how the funds are used here. It does say that:

"IPPFAR [IPPF Africa Regional Office] also mobilizes resources for its MAs ([member Associations], and advocates for sexual and reproductive rights at the county, regional and international level."

There's that "advocacy" word again.

And you may be asking, what about the due diligence that our money is not being used for abortion services is Afghanistan, Mali and the Sudan? Good question. My ATIP revealed this:

"Please note, no records were found for Afghanistan, Mail or Sudan."

Apparently those field visits and regular monitoring to three of the five countries to "determine and assess whether the implementing organization is performing or delivering services in accordance with the terms and conditions of the funding agreement." never even happened.

(Note: this ATIP was for the first Annual Progress Report for the project: 27 January - 31 March 2012, and for the Mid-year Report: 1 April - 30 September 2012. There will be additional reports for each year of the funding.)

What's going on in Bangladesh?

Detective: Mr. Smith, did you murder your wife?
Mr. Smith: No detective, I did not.
Detective: Can I have that in writing please?
Mr. Smith: I, John Smith, did not murder my wife. Signed John Smith.
Detective: Okay Mr. Smith, you're free to go. Have a nice weekend!

This is similar to how it appears CIDA satisfies its due diligence responsibility, regarding our $6 million funding to IPPF, as it relates to Menstrual Regulation (MR) services in Bangladesh.

(MR is an abortion only if the woman is pregnant; so not all MR's amount to abortions. Because they don't check whether the woman is pregnant first, laws that ban abortions can be circumvented, since they don't actually know that she is pregnant. But if she is pregnant, then MS is an abortion.)

Here is correspondence between CIDA and IPPF on this subject. I received the information through an Access to Information request. There are two separate instances of such correspondence.

The first exchange occurred on October 3, 2011.

(Note: I use the word "IPPF" to identify the IPPF employee in the email exchange. "CIDA" is used to identify the CIDA employee.)

............

Dear IPPF,

Just as ___  predicted on Friday, CIDA is now being called on to discuss IPPF's activities in Bangladesh, specifically with regard to "menstrual extraction" or "menstrual regulation". Can you please provide information on whether or not IPPF supports this practice/offers this service in Bangladesh, and if you do, how? How can concerned donors be assured that funding to Bangladesh will not support this practice if it can in fact be called abortion or "an abortion-related-service"? What is IPPF's position? (If possible, can you also provide the text of the response you issued to the media in response to the same inquiry?)

FYI, our response will likely re-emphasize what IPPF and CIDA have maintained---that Canadian funding will not support abortion-related services---, but the decision is far from mine to make.  

Thanks very much, 

CIDA 

............

Hi CIDA, 

I hope you are well. 

I am happy to send you the IPPF Bangladesh Brief in response to the questions you have posed. I would like to particularly highlight that menstrual regulation is not a part of IPPF's proposal to CIDA. 

As discussed, our revised proposal focuses on the delivery of increased access to family planning services. 

I do apologise for the delay in sending this brief to you. As you know, our budget meetings have been ongoing this week, meaning we were a bit thin on the ground. Thank you for your patience and understanding! 

Please do let us know if you require any further information. We are always happy to help! 

With best wishes, 

IPPF

............ 

Hi IPPF, 

Thanks very much for the information! We appreciate your help, as always. I hope the budget meetings were fruitful. 

............

Then on March 15 2013 we see another similar exchanger between IPPF and CIDA.

...........

Hi IPPF, 

Further to our conversation today, I wanted to clarify something from your recent Semi-Annual Report. 

In a document you provided us a little while back entitled IPPF, Bangladesh and Menstrual Regulation, you indicate that "No Canadian money will be used for abortion services or menstrual regulation services." However, in your recent Semi-Annual report to CIDA (April-September 2012), menstrual regulation is listed as an activity undertaken by FPAB. 

Could you please confirm that, as per the document quoted above, CIDA funds are not used to cover these menstrual regulation services undertaken by FPAB? 

Many thanks ___. Wishing you a wonderful weekend! 

CIDA

............ 

Dear CIDA, 

I, ____ confirm that no funding from CIDA will be used for abortion services or menstrual regulation services including activities undertaken by FBAB in Bangladesh. 

As per the IPPF, Bangladesh and Menstrual Regulation brief, we confirm that FPAB does offer menstrual regulation services. This is in line with government regulations and other service providers in Bangladesh. 

However, no CIDA funds are used to support these activities. 

IPPF

Well there you have it folks. Right from the horse's mouth.

 

 

(The document in question that was in IPPF's semi-annual report.)