Action Canada for Sexual Health and Reproductive Rights spends your taxes on abortion and contraception

Action Canada for Sexual Health and Reproductive Rights most recent lobbying of the government this week.

Their revenue for year ending 2024-06-30:

	Receipted donations $1,405,669.00 (13.11%)
	Non-receipted donations $86,134.00 (0.80%)
	Gifts from other registered charities $563,733.00 (5.26%)
	Government funding $6,214,388.00 (57.96%)
	All other revenue $2,452,805.00 (22.87%)

Total revenue: $10,722,729.00

Action Canada received $6,214,388 from the government in 2024. Their total salary costs were $3,268,787. If we add in professional and consulting fees of $727,931 and Education and training for staff and volunteers of $535,594, we get a total of $4,532,312. (Numbers from CRA)

We could say then, that about 73% of the government grants Action Canada for Sexual Health and Reproductive Rights receives, goes to salary costs, so these pro-deathers can then turn around and lobby the government to push for more abortion in Canada and internationally. And now they are also pushing for contraception in Canada and around the world. 

CPSO - Getting rid of pro-life doctors

The pro-abortions seem quite gleeful that doctors will now be forced to provide abortions and contraception.

Dr. Carol Leet president of CPSO says there have been complaints:

"There have been some complaints about access to care".

How many complaints? A handful? One?

Its pretty hard to believe that access is a problem, with the number of "pro-choice" doctors out there.

So what's the real motivation for this policy? I think CPSO just wants to rid their profession of pro-life doctors. Discrimination by any other name.

CPSO is taking a dangerous position on conscience rights

The College of Physicians and Surgeons of Ontario (CPSO), wants to change how doctors are required to refer for care. Their draft policy, Professional Obligations and Human Rights states:

“Where physicians are unwilling to provide certain elements of care due to their moral or religious beliefs, an effective referral to another health care provider must be provided to the patient. An effective referral means a referral made in good faith to a non-objecting, available and accessible physician or other health-care provider. The referral must be made in a timely manner to reduce the risk of adverse clinical outcomes. Physicians must not impede access to care for existing patients, or those seeking to become patients”

Here are four reasons why CPSO shouldn't go ahead with this bad policy.

1) Freedom of conscience for doctors. It is wrong to force doctors to betray their conscience. This is not a difficult concept to understand. A civilized society does not force anyone to act against their conscience. And if a doctor is forced to refer for a procedure that is against her conscience, she is complicit in the act itself, which is the same (morally) as performing the act herself. This is wrong and against every moral definition one can think of.

2) Patient/doctor trust. If a patient knows their doctor can leave their conscience at the door when it comes to abortion, contraception or assisted suicide, how can the patient be expected to trust their doctor with their other health issues?

3) Retroactive requirements. Changing the guidelines in this way, is an unethical act towards the doctors affected. When doctors who are currently practicing, or are in medical school, first became doctors, they did so with the understanding that they would be able to conscientiously object to procedures that are against their conscience (including referring to another doctor).

This change would be a retroactive requirement of being a doctor. This is patently unfair to doctors. It means that doctors who are already in the profession or are in medical school, and chose the profession based on the current guidelines that do uphold their freedom of conscience rights, will now be expected to act according to a new and very different set of rules. Many doctors would have no choice but to leave their chosen profession in order to not be forced to be complicit in acts they find morally reprehensible.

4) Loss of livelihood to doctors. The huge investments required to become a doctor in the first place (time, money, family dependency on the doctor's livelihood, etc), would all be thrown away. Not only would these doctors who have invested large sums of money and time in becoming a doctor be forced to quit, but their entire livelihood would be at risk, and the livelihood of their families.

Dr. Marc Gabel who works for CPSO and is the chair of the college’s policy working group reviewing “Professional Obligations and Human Rights”, seems to have no problem with the harmful consequences this policy would impose on doctors:

“It may well be that you would have to think about whether you can practice family medicine as it is defined in Canada and in most of the Western countries.”

Dr. Gabel's flippant dismissal of the very real dilemma this new policy would incur for many doctors is worrisome. Forcing doctors to either refer for procedures that go against their conscience or, leave their profession altogether, is not a trivial matter.

These are all very serious considerations. CPSO and Dr. Gabel need to seriously rethink this policy because of these negative outcomes for doctors, the patients they treat, and society as a whole.

Doctors and members of the public can comment on the draft policy up to Feb. 20. Submit your comments here.

Freedom of conscience is for everyone including doctors

I'm always dumbfounded by the inane and gloriously off-the-wall-and-off-topic-comments I often read on articles posted online on anything that could be even remotely associated with pro-life viewpoints.

To see what I mean check out Andrea Mrozek's thoughtful and coherant article posted on Huffington Post about doctor's freedom of conscience rights.

I think some of these commentors might want to stop talking about their disdain at doctors practicing freedom of conscience rights--which I might add are actual rights and not make-believe rights like "abortion rights"--and instead educate themselves on the subject.

But no. They'd prefer to hear themselves blather on instead. I think they just like to see their name in print. I guess it makes them feel important.

So here's the thing. Freedom of conscience is a right guaranteed under our Canadian Charter. That means everyone, including doctors have this right. It's not a right for the few, it is a right for all.

If you don't like the fact that a doctor won't provide you with your contraception, then you are free to go elsewhere for it. Nobody's forcing you to go to that doctor. The choice crowd is in love with the word "choice". So use it. Because I'd prefer to know my doctor bases his medical expertise in concert with his conscience, and doesn't ignore it. I imagine there were doctors who went against their conscience in the concentration camps in Auschwitz. Not something (I hope) we would ever want from our own doctors.

Here's something else to ponder for those who who like to hear themselves talk and say nothing. Joyce Arthur also thinks conscientious objection for doctors shouldn't be allowed. But surprisingly, not all of her compatriots agree with her: Global Doctors for Choice, bpas (The British pregnancy Advisory Service), and the International Journal of Gynecology and Obstetrics (IJGO), all believe that conscientious objection should be allowed.

To do - write to CPSO

Send your comments in to the College of Physicians and Surgeons of Ontario (CPSO) on their Human Rights Code Policy review, by August 5, 2014.

It is very important that every right thinking Ontario person do this. Our conscience rights and freedom of religion rights are supremely important to defend.

When we tell doctors to leave their conscience at the door, we are in effect saying, that we condone their acting unethically and immorally. That is what is meant, by not allowing our conscience to guide our actions. It is a very dangerous road to travel.

Our Church provides an excellent sample letter for people to use.

Looking for doctors who support conscientious objection

I understand that some doctors have been writing to newspapers regarding their freedom of conscience rights. And that maybe those letters haven't been published in those newspapers.

If you or someone you know has written such a letter, if you want to send it to me I would be happy to publish them on my blog.

Send to me at maloneyp64@gmail.com

Joyce Arthur: Conscientious objection should be punished

As we know, the College of Physicians and Surgeons of Ontario is reviewing their policy on conscientious objection (CO), and is looking for input from physicians and the public on their website. CPSO are also posting comments from anyone who would like to contribute to the policy.

Interesting comments on both sides of the debate.

And then there's Joyce Arthur's view on the topic. Arthur co-wrote a paper with Christian Fiala called “Dishonourable disobedience” – Why refusal to treat in reproductive healthcare is not conscientious objection

See below for some of Arthur's extreme opinions on conscientious objection. An extreme view by an extreme person. No surprise there.

But it's what happened next that was surprising. After Arthur's article was published, her paper was actually criticized by a pro-choice group: the British Pregnancy Advisory Service (bpas).

Jennie Bristow, editor of Reproductive Review, (the educational arm of BPAS) states:

"It is true that campaigns against abortion have often appropriated the language of ‘conscience’ to push across a more political agenda. However, there are good reasons why prochoice advocates have supported the ability of medical professionals to opt out of performing a procedure that goes against their conscience. The idea of forcing a doctor to perform an abortion when he or she thinks that this is murder sits very uncomfortably with the principles at the heart of a liberal society. So too, of course, does the idea of forcing a women to continue with a pregnancy that she does not want. 

In this regard, choice goes both ways; no woman or doctor should be forced to have or perform an abortion, but women and doctors should be free to choose for themselves whether to have or perform an abortion. That is ultimately why having laws that ban or restrict abortion are such a problem...

...compelling doctors to perform abortions against their wishes would, conversely, lead to unpleasant care for women and set a worrying precedent about how much the law can dictate the beliefs and practice of those working in reproductive healthcare. This includes those doctors and nurses who are motivated by their consciences to perform abortions, and care for the women who need them. 

The problem of abortion is one of too much legal regulation and restriction already. It is hard to see how laws designed to compel professionals to act against their conscience can be of benefit to anybody." (emphasis mine)

Arthur's position was also criticized by by Wendy Chavkin, Global Doctors for Choice.

We are all concerned that conscience-based refusal to provide contested components of reproductive health care exacerbates limited access to such care and thus threatens women’s health and rights. Where we differ with Arthur and Fiala is in our analysis of the issues at stake. We believe that there are competing rights here, and that resolution of such tension is primarily a societal, not individual, responsibility. We also differ in our pragmatic assessment of how best to proceed. 

From the human rights perspective, we see the ability to exercise conscience as fundamental to individual integrity. In fact, allegiance to this principle undergirds our collective defense of the individual woman’s right to autonomy in reproductive decision-making. The international and human rights covenants cited all concur that the individual’s right to hold and manifest beliefs and religion are essential, and subject only to limitations necessary to protect the fundamental rights of others. International and national professional associations have similarly defended the individual clinician’s right of conscience while also asserting that it should be circumscribed by the primary duty to the patient, including requirements to disclose, refer, and impart accurate information, and provide care in cases of emergency. 

The obvious tension here is when the rights of individuals collide: the objecting clinician’s right to refuse, another clinician’s conscience-based commitment to providing that care, the woman’s right to follow through on her conscientiously chosen course of action. (emphasis mine)

Then Arthur apparently felt defensive of her radical views in this rebuttal to their criticism:

"We received several critiques, one published in bpas Reproductive Review, another in RH Reality Check by Global Doctors for Choice, and a few informal criticisms relayed on listservs or online comments, and at a recent conference in Lisbon, Portugal, where we presented our ideas. We paraphrase these criticisms below – most of which we feel ignored or misunderstood our position – and follow with our response."

That's got to be a first. Pro-choicers not agreeing with every confused word that comes out of Joyce Arthur's extremist pro-abortion mouth.

No wonder pro-choicers felt compelled to comment on Arthur's views. Even they realize the importance of conscientious objection for doctors.

Below are excerpts from Arthur's and Fiala's original paper. Arthur's extremist nonsensical views pretty much speak for themselves.

(all emphasis are mine)

"Healthcare professionals who exercise CO are using their position of trust and authority to impose their personal beliefs on patients, who are completely dependent on them for essential healthcare. Health systems and institutions that prohibit staff from providing abortion or contraception services are being discriminatory by systematically denying healthcare services to a vulnerable population and disregarding conscience rights for abortion providers." 

"Some argue that abortion is a type of killing (of the foetus or embryo) and therefore CO is just as relevant in medicine as in the military. However, killing a living person in war cannot be equated with stopping the development of a gestational sac or foetus. 

Abortion and contraception preserve the health and lives of women, while those practicing CO put women's lives at risk and sometimes even sacrifice them (Attie & Goldwater Productions, 2005)."

"Because reproductive healthcare is largely delivered to women, CO in this field has implications for women's human rights and constitutes discrimination. Women are often expected to fulfil a motherhood role, so they frequently face ignorance, disapproval, or even hostility when requesting abortion. In these circumstances, the exercise of CO becomes a paternalistic initiative to compel women to give birth."

"Abortion is a necessary health intervention, as well as highly ethical."

"Termination of unwanted pregnancy is ethical because women do so only if they don’t see any responsible way to care for that potential child."

"Canada already struck down its law entirely in 1988 and never replaced it, proving that criminal abortion laws are unnecessary and counter-productive."

"Anti-choice objections to providing abortions are based on a denial of this evidence and historical experience. The provision of safe, legal abortion is a vital public interest that negates any grounds for CO."

"Doctors who invoke CO to not perform abortions can benefit professionally by spending more of their time delivering more “reputable” or higher status treatments compared to their abortion-providing colleagues. As a result, they can escape stigma and boost their careers, reputations, and salaries."

"When access to abortion care is reduced, restricted, and stigmatized in so many ways, allowing any degree of CO adds further to the already serious abrogation of patients’ rights and medical ethics."

"CO in reproductive healthcare is largely unworkable and inappropriate, and arguably unethical and unprofessional as well."

"The reliance on a doctor to protect one's life and health makes any right to CO in medicine unethical – and downright dangerous in light of the fact that women often resort to unsafe do-it-yourself abortions when they are unable to access medical care. If peoples’ right to life means anything, they must be able to access necessary healthcare, which should supersede the conscience rights of others."

"CO gives a person a pretext not to do their job, even though they were specifically hired to do that job and are being paid for it."

"The principle of public accommodation requires the discounting of individual conscience within a profession. Everyone's conscience is different and cannot be coerced, which is why a free democratic society places a high value on tolerance and equal respect for all citizens. However, if individuals are permitted to exercise their conscience when serving the public, it gives social sanction to the practice of intolerance. CO invites discrimination against people needing the services being refused, and infringes their freedom of conscience."

"The exercise of CO becomes an excuse for the doctor to exert personal power over the patient by imposing their own views."

"Even doctors who exercise CO within the law are arguably unsuited for their position because they are demonstrating an inability to perform their job – that is, they are allowing religious beliefs or some other personal issue to interfere with their job performance to the extent of negating their professional duty to patients."

 "we propose that healthcare providers be prohibited from a blanket right to refuse to perform or refer for abortion or dispense contraception for personal or religious reasons."

"we propose the following specific remedies to reduce and eventually eliminate CO in reproductive healthcare. Everyone aspiring to enter health professions that involve reproductive healthcare should be required to declare that they will not allow their personal beliefs to interfere with their management of patients to the point of discrimination. Medical students entering the Ob/Gyn specialty should be informed about the full scope of the specialty, including treating women with unwanted pregnancies. Students should be rejected if they do not wish to learn and prescribe contraception or perform abortions for CO reasons. All Ob/Gyns should be required to dispense birth control and perform abortions as part of their practice (unless there is a legitimate medical or professional reason not to). General practitioners should be expected to dispense contraception if requested, and perform abortions if they have the skills and capacity, or else refer appropriately. Pharmacists should be compelled to dispense all lawfully prescribed drugs without exceptions. Institutional CO should be completely prohibited for health systems and businesses that serve the general public."

"Monitoring and enforcement measures should be put into place to ensure that prohibitions on CO are followed. After all, CO is a form of resistance to rules or laws, so those who exercise CO must be prepared to accept punishment for their disobedience, just as in any other profession. Doctors should be sanctioned when they violate laws or codes of ethics that prohibit CO. Disciplinary measures could include a review process, an official reprimand and order to correct, and could escalate to loss of medical license, dismissal, or even criminal charges. In addition, any costs involved in the exercise of CO should be borne by the health professional or institution, who must be held liable for any health risks and negative consequences of their refusal. Patients should be legally entitled to sue and to claim compensation for any physical or mental harm, and for additional costs resulting from the refusal to treat."

"Other needed measures include compulsory training in contraception provision and abortion techniques at medical schools, security measures to protect doctors and patients such as clinic buffer zones, full funding of contraception and abortion through government health insurance, public education to reduce abortion stigma, and other initiatives." 

"Healthcare workers’ refusal to participate in reproductive care such as contraception and abortion is not a “conscientious objection;” rather, it is a refusal to treat that should be seen as unprofessional. A just society and an evidence-based medical system should deem it as “dishonourable disobedience,” an ethical breach that should be handled in the same way as any other professional negligence or malpractice, or a mental incapacity to perform one's duties."

"By manipulating women into continuing an unwanted pregnancy against their best interests, the exercise of CO undermines women's self-determination and liberty and risks their health and lives. As such, it has no place in a democratic society."

No consciences allowed

The College of Physicians and Surgeons of Ontario are looking for input on and their Physicians and the Ontario Human Rights Code policy.

I could ever only respect a doctor who practices medicine in a way that is in complete harmony with his conscience. This is crucially important and I would not want to see a doctor who did anything against what his conscience was saying to him.

Here is a real life example of conscience rights gone awry. When Justin Trudeau announced his can't-be-a-pro-life-candidate-for-the-Liberal-party policy, MP Lawrence MacAulay thought he would be permitted to vote with his own personal beliefs, which are anti-abortion:

"MacAuley, who has been an MP since 1988, said last week he expected to be permitted to vote on side with his own personal beliefs which are anti-abortion. 

A spokesperson for the Liberal Party quickly contradicted this statement, stating any Liberal MP will be expected to vote in favour of abortion. 

MacAulay later backtracked on Twitter, stating: “I accept and understand the party position regarding a woman’s right to choose. Despite my personal beliefs, I understand that I will have to vote the party position should this issue ever come up in the House of Commons.”"

This is very troubling. MacAuley says he is pro-life. But then at a flick of a can't-be-a-pro-life-candidate-for-the-Liberal-party switch, MacAulay says he would now support the party position on abortion--against his own conscience.

And freedom of conscience is a right guaranteed by our Charter of Rights and Freedoms. And for very good reason. It is how we want all good people to respond to issues of ethics and morality. They pay attention to their conscience.

In purely practical terms, doing away with freedom of conscience rights for doctors will have the following negative outcome.

Good doctors, after years and years of training will leave the profession. This would be a lose-lose situation. The doctor and his family suffer from the loss of his/her livelihood. The public would suffer since we already have a doctor shortage, and this would only make it worse.

We do not want good doctors to leave the profession. For what? So that a woman can be guaranteed to be able to obtain the birth control pill or an abortion from every single doctor in the country, when there are already (some might say too many) doctors filling the need? Is this really what we want of our doctors? I hope not.

And make no mistake. The only reason the issue has come up at all, is because of contraception and abortion.

It will also mean we will now have institutionalized discrimination against pro-life doctors. Just like we have institutionalized discrimination against pro-life politicians in two of our three political parties in Canada. Let's not go there.

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.

How to help women on International Women's Day

MaterCare International really has a hard time of it. They've tried eleven times to get government funding for the compassionate maternal care work they do in third world countries.

MaterCare's work entails a do-no-harm brand of care.

International Planned Parenthood (IPPF) on the other hand, who does receive government funding, has a brand of "care" that consists of providing contraception to third world countries.

(See these links for the last funding IPPF received)
http://run-with-life.blogspot.ca/2012/01/matercare-background-on-cida-refusing.html
http://run-with-life.blogspot.ca/2012/01/atip-cida-and-ippf-more-to-come.html
http://run-with-life.blogspot.ca/2012/01/atip-cida-and-ippf-part-2.html
http://run-with-life.blogspot.ca/2012/01/atip-cida-and-ippf-part-3.html
http://run-with-life.blogspot.ca/2012/01/atip-cida-and-ippf-part-4.html

Even though the funds IPPF received from CIDA are not supposed to be used for abortions, it does include emergency contraceptives and IUDs which many consider to be abortifacients.

And we know that IPPF includes abortion (code words "sexual and reproductive health and rights") in its "core values". IPPF believes abortion is a "human right" and are "Advocating for all governments to decriminalize abortion".

So how do we know IPPF is not using this CIDA funding to provide for, or advocate for, abortions? In fact, what mechanisms are in place on the ground in the five affected countries, to make sure this doesn't happen? Does anyone know? Because I don't.

One could make the case that IPPF's brand of "care" is more of the "we know what's good for you" variety. The kind that sticks its big nose into these very poor countries by imposing their own "values" on these exceedingly poor and underprivileged women's autonomy. Kind of like "for your own good" kind of care.

Instead of helping MaterCare and the good work they do, our tax dollars go to IPPF to "help" third world women. Makes me want to be sick.

MaterCare has set up a petition they will send to Mr. Harper to advocate for a positive kind of maternal health care that actually helps women and children. The kind of care Canadians would be proud to contribute to. The kind of care that dare I say it, saves lives.

Maybe these pathetic eleven years of refusing funding to MaterCare should come to an end. What do you think Mr. Harper, is it finally time to do something about this?

ATIP: CIDA and IPPF (Part 4)

Attached are the appendixes which provides the details of the proposed deliverables by IPPF for the Muskoka initiative on maternal and child health initiative.

Click on each picture, print, then place them side by side to get the full table.

ATIP: CIDA and IPPF (Part 3)

Below I have scanned the Programme Goals and Objectives of the proposal to CIDA from IPPF for funding from the Government’s Muskoka initiative on maternal and child health initiative approved by Minister Oda (pages 7, 8, 9, part of page 10, and part of page 12).

I also referred to some of what is below, in my previous entry.

Sorry for the length of this entry.

--------------------------------------------------------------------------------

Programme Goal
All people, particularly the poor, marginalized, the socially excluded, and underserved are able to exercise their right, to make free and informed choices about their SRH, and have access to SRH information, sexuality education and high quality services, including family planning, all of which are stigma-free, sensitive to gender dynamics and sexual diversity, and offer a positive approach to sexuality. (10)

Objectives
1. To ensure access to IPPF quality-assured, client-oriented, rights-based and integrated package of SRH services including family planning, ante-natal care, STI prevention and care including HIV;
2. To ensure affordable community based outreach services and easy access to services, with a focus on the poor, marginalized and socially-excluded, stigmatized and underserved women and young people;
3. To ensure contraceptive and RH commodity security and to promote under-utilized and new contraceptive technologies;
4. To strengthen health systems through strong partnerships

Expected Results (11)
In partnership with CIDA, IPPF will deliver a comprehensive response to the Muskoka Initiative at two levels - globally and at country level. Globally, IPPF will drive the delivery of expected results and contribute to:
o Preventing the deaths of 1.3 million children under five years of age;
o Preventing the deaths of 64,000 mothers;
o Giving access to modern methods of family planning for 12 million couples


Through funding from the Government of Canada, IPPF's network of service delivery MAs based in 5 ountries (12) will deliver:
• 307,273 unintended pregnancies averted; (13)
• 1,229,092 CYPs provided by method including 98,971 IUD, 191,450 sterilization, 623,706 oral contraceptive pills, 140,511 condoms, 134,104 Injectables, 28,964 Implants, 10,438 Other Barrier Methods, 89 Other Hormonal Methods;
• 3,676,063 SRH services (excluding family planning) and provided by type of service: 186,623 gynaecological, 1,551,019 maternal and child health, 476,518 STI and RTI, 697,166 HIV and AIDS, 436,459 other SRH medical, 571 urological, 35,161 infertility;
• 5,738,052 SRH services including 3,245,485 family planning services provided to young people under age 25;
• 7,090,090 family planning (FP) services provided by method provided by type of service: 37,943 IUD, 19,192 sterilization, 5,196,801 oral contraceptive pills, 1,190,709 condoms, 511,674 Injectables, 67,440 Implants, 18,256 Other Barrier Methods and 568 Other Hormonal Methods;
• 1,321,938 HIV-related services provided along the prevention to care continuum
• 70 estimated percentage of Member Association's clients who are poor, marginalized and/or socially excluded.


A Logical Framework is presented at Annex 1 to demonstrate the programme's goal, objectives, idicators, targets, and contribution to the MDGs. Annex 2 includes a breakdown of these figures by member Association.


Strategy and Approach
IPPF proposes to scale-up services focused on delivering a core set of health outputs in 5 countries. We will drive the delivery of expected results in line with the Muskoka Initiative through IPPF's strategic Goal on Access. Our approach builds on IPPF's global experience of comprehensive family planning programming and the provision of integrated services, lessons learned and best practice hared among our network of MAs.


Objective 1: To ensure access to IPPF quality-assured, client-oriented, rights-based and itegrated package of SRH services including family planning, ante-natal care, STI prevention and care including HIV

Over 31 million clients, men or women, married or unmarried, young or old visit our 64,500 service delivery points every year. Every client visiting an IPPF service delivery point can expect to receive a holistic and integrated package of services. Clients arriving at our clinics for contraceptive services will typically be informed about other common SRH issues. They will also be offered the choice to be asked a set of rapid and standardized screening questions to elicit STI symptoms, safer sex practice, including condom use and voluntary counselling and testing (VCT), risks of gender-based violence, and as appropriate reproductive cancer screening history, such as cervical cancer. Additionally, every client coming to the service delivery points for non-contraceptive services will be asked about their contraceptive practices, family size and child-spacing desires. These services are essential integrated package of SRH services that IPPF MAs endeavour to make available at the primary level of care.


Our service delivery points are designed to be non-intimidating, as well as user and youth-friendly. They offer a safe space free from stigma and judgment. Our SRH information and services emphasize a positive approach to sexuality. In settings with a shortage of doctors, and whenever safe and effective, we train and provide supportive supervision to community-based health workers and mid-level providers to deliver specific procedures. This ensures that clients in resource-poor settings are still able to access high quality services from trained service providers.


• Quality-assured, client-centred care
Quality-assured and client-centred care means that clients' needs guide the planning and implementation of our services. IPPF services meet clinical standards, which require the commitment and expertise of clinic managers and service providers. We believe that clinic and programme tanagers, service providers and clients, all play a role in achieving quality-assured, client-centred care.

IPPF will strengthen the quality of care at service delivery points, taking into account our commitment to a holistic, no-missed opportunity and stigma-free approach through providing:


o Updated self-assessment checklist tool to reflect most recent technical developments.
o Guidelines and job-aids based on current global standards (WHO Medical Eligibility Criteria, Selected Practice Recommendations, or Decision Making Tool for Family Planning, including the tool for people living with HIV)
o A revised Quality of Care tools through revised edition of `IPPF Medical Service Delivery Guidelines, (14) which complements 'IPPF's Global Handbook on Family Planning. (15)


Objective 2: To ensure affordable community based outreach services and easy access to ervices, with a focus on the„poor marginalized and socially-excluded, stigmatized and underved women and young people

IPPF MAs are committed to ensuring easy access to services by using an integrated model of service delivery points, which are conveniently available to everyone, especially to the poor, marginalized, socially-excluded, stigmatized and underserved. All services are of quality, free of unnecessary administrative and medical barriers. People can choose from a wide range of SRH services and a large mix of contraceptive methods.


• Innovative outreach channels
Our MAs offer services through multiple channels, including static and mobile clinics, community-based distributors, retail outlets and other public and private-sector providers. IPPF's community-based health workers offer information and education as well as contraceptives such as condoms and oral contraceptives. They refer people to clinics for other contraceptives and SRH services. IPPF offer clients a larger mix of contraceptives, and in particular long-acting and reversible contraceptives (LARC), such as IUDs and implants, through mobile clinics.


We build the capacity of primary health care public and private-sector providers on new contraceptive technologies, supply them with contraceptive commodities where needed, and offer them regular technical support and supportive supervision. As grassroots organizations part of the national health system, IPPF MAs are committed to strengthening the health care system where they operate.


• Information and education
IPPF's high quality and accessible services are pointless if people do not know about them or want them. Demand generation will be conducted through a combination of channels, such as mass media, interpersonal and community channels, in order to maximize the effect of behaviour change communication (BCC). Instead of one-time BCC campaigns, we will ensure sustained healthy behaviour through continuous communication materials and campaigns.


Objective 3: To ensure contraceptive and reproductive health commodity security and to promote under-utilized and new contraceptive technologies

IPPF aims to deliver a continuous supply of a variety of contraceptives, so that clients can choose their preferred method without interruption whenever they want. Other SRH commodities needed to implement the integrated SRH package, such as antimicrobials for STI treatment, will also be secured. IPPF and our MAs will promote and offer under-utilized and new technologies:


o Oral contraceptives, emergency contraceptive pills and condoms are known to be challenging to use perfectly and consistently. These short acting methods will be readily available and accessible to people using such methods, including young people. J
o LARC (16) and surgical methods such as IUDs, vasectomy and bilateral tubal ligation, based on the needs of communities and the training needs of service providers.
o We will continue to participate in research and development initiatives with partners such as the World Health Organization (WHO), by piloting new service delivery models and contraceptive technologies, such as the Uniject injectable contraceptive that will be available by 2012. (17)


Objective 4: To strengthen health systems through strong partnerships.

IPPF MAs will continue to build on partnerships with key agencies, including Ministries of Health
(MOH), and UNFPA Country Offices to strengthen health systems. Most is participate in me annual planning meetings of their respective UNFPA Country Office and MOH, and play an important role as their implementing partner. (18) Many MAs play a critical role as national service providers on behalf of the government, with whom they have contractual arrangements.


Throughout the proposed initiative, IPPF MAs will continue to partner with key agencies, including
MOH and UNFPA Country Offices. In addition we will strengthen our collaboration with other national partners, such as:

o The national branch of the International Federation of Obstetrics and Gynaecology (FIGO), with whom IPPF also has a global Memorandum of Understanding. Many of our MAs' volunteers belong to the national FIGO branch, and will provide technical assistance through competency-based training on new contraceptives or quality of care supervision to our service providers;
o Public and private-sector providers will play an important role as implementing partners of the social franchising of our integrated SRH delivery models. We will give emphasis on training them on under-utilized and new contraceptive technologies;
o Training institutions, including nursing, midwifery, medical schools and MOH, to ensure that their pre-service training curricula are up-to-date with regard to contraceptive and SRH technologies, and quality of care standards.


10 IPPF Strategic Framework Goal 4: Access to SRH services.
11 The program expected results are based on expected results in 5 countries as presented in the Logical Framework Analysis at Annex 1
12 Member Associations selected work in OECD DAC recipient countries
13 Number of Pregnancies Averted is currently calculated using the impact calculator. The Impact Calculator is currently being used by the Futures Group to harmonize Couple Years of Protection conversion. Multiples of the three are generally used worldwide by USAID, WHO, and MSI. IPPF uses the lowest values so as to not inflate performance. If IPPF used the highest, its CYP would be 45 per cent higher.
14 'IPPF Medical Service Delivery' can be accessed at
http://www.ippf.org/en/Resources/Guides-toolkits/IPPF+Medical+and+Service+Delivery+Guidelines.htm
15 Global Handbook on Family Planning' can be accessed at
http://www.ippf.org/NR/rdonlyres/E8AA38AE-AE7A-4D35-BD57-A55D2B4BE7A5/0/Family_Planning_Global_Handbook.pdf
16 LARC and surgical methods are known to be more cost-effective in terms of couple years of protection (CYP) than short-term methods, such as condoms, Injectables and oral contraceptive pills. LARC methods may be suitable for many clients but require frequent repeat visits.
17 Uniject has an integrated hypodermic needle and a small squeezable bubble-like container, Uniject has the potential to improve the safety and acceptability of injectable contraceptives given by service providers, and in particular by community-based distributors. Uniject will be easier for clients to self-administer their injectable contraceptive in the privacy of their home, which is in line with the demedicalization philosophy of IPPF.
18 UNFPA-IPPF collaboration is backed up by a global Memorandum of Understanding and action plan that was updated in July 2010 by both agencies.


(and this from page 12):


Eligible Countries
IPPF will deliver a comprehensive response to the Muskoka Initiative at the country level in Afghanistan, Bangladesh, Mali, Sudan and Tanzania. IPPF's Secretariat, through joint collaboration with Central and Regional Offices, will drive expected results globally in line with the Muskoka Initiative through IPPF's Strategic Goal on Access. The Secretariat will also manage the programme through offering technical expertise on comprehensive family planning and other SRH services, and the development, harmonization and implementation of the programme's main components. Central Office and Regional Offices will also support selected MAs in terms of technical assistance and capacity building. The Secretariat will support implementation in areas such as financial and human resources management, resource mobilization and monitoring and evaluation. 75 per cent of the programme budget will be allocated to MAs to deliver health outcomes in the 6 countries. The 6 MAs all fall into the list of 49 low-income countries identified in the Taskforce on Innovative International Financing for Health Systems (22) the Muskoka Initiative (23) and CIDA priority countries.

IPPF will ensure that no MA will use Canadian funds for abortion activity. In the past certain Governments have placed various legislative or policy restrictions on the use of funds, including for induced abortion services. IPPF has procedures in place that can immediately be reinstated to ensure that no funds from the Government of Canada are used for abortion services. This includes he holding of funds in a separate bank account.


22 The Taskforce on Innovative International Financing for Health Systems identifies 49 low-income countries where investments in national health systems would save four million children and babies annually, and up to 322,000 maternal deaths, and 193,000 adult HIV deaths.
23 The Muskoka Initiative is focused on achieving significant progress on health systems strengthening in countries with high burdens of maternal and under-five child mortality and an unmet need for family planning.

ATIP: CIDA and IPPF (Part 2)

Further to my last entry on my Access to Information and Freedom (ATIP) request to CIDA...

I actually made two ATIP requests.

My first request asked for the signed funding agreement between CIDA and IPPF for the $6 Million funding IPPF would receive, as part of the Government’s Muskoka initiative on maternal and child health initiative approved by Minister Oda. I was informed that the agreement hadn’t been signed yet.

So I revised my first ATIP request, and asked to see the actual IPPF proposal itself, since we had heard that IPPF would receive $6 million.

I received back the 54 page proposal. It came with the following qualification in CIDA’s covering letter:
"For your information, IPPF's recent proposal does not reflect the terms of the approved program and CIDA has not yet signed a funding agreement with IPPF."

We do know that IPPF asked for $6 million, and news reports said they will get $6 million. Therefore, I imagine the funding agreement will be pretty close to the proposal but that remains to be confirmed.

Sprinkled throughout the proposal, is the mention of all kinds of contraceptives, emergency contraceptives and IUDs, including charts of how many of these will be provided.

Many consider emergency contraceptives and IUDs to be abortifacients.

On Page 12, I learned that:
"IPPF will ensure that no MA [member association] will use Canadian funds for abortion activity. In the past certain Governments have placed various legislative or policy restrictions on the use of funds, including for induced abortion services. IPPF has procedures in place that can immediately be reinstated to ensure that no funds from the Government of Canada are used for abortion services. This includes the holding of funds in a separate bank account."

What I'd like to know is, what mechanisms will be in place on the ground, to ensure that abortion services are not provided or referred?

On Page 7 under Program objectives and Components, Programme Goal:
"All people, particularly the poor, marginalized, the socially excluded, and undeserved are able to exercise their right, to make free and informed choices about their SRH [Sexual Reproductive Health], and have access to SRH information, sexuality education and high quality services, including family planning, all of which stigma-free, sensitive to gender dynamics and sezual diversity, and offer a positive approach to sexuality."

This above type of wording permeates the entire proposal.

On Page 8 under Program objectives and Components, Quality-assured, Client Centred care:
"IPPF will strengthen the quality of care at service delivery points, taking into account our commitment to a holistic, no-missed opportunity and stigma-free approach through providing:

Updated self-assessment checklist tool to reflect most recent technical developments.

Guidelines and job-aids based on current global standards (WHO Medical Eligibility Criteria, Selected Practice Recommendations, or Decision Making Tool for Family Planning, including the tool for people living with HIV)

A revised Quality of Care tools through revised edition of `IPPF Medical Service Delivery Guidelines, (14) which complements 'IPPF's Global Handbook on Family Planning. (15)"

Another question I have: If abortion services are not being provided, then why would they provide these manuals which discuss all aspects of abortion, at the "service delivery points"?

Here are a few interesting items from these guidebooks (Note that the guidebooks themselves are not part of the proposal, they are only referred to in the proposal. With a total of 840 pages in these two guidebooks, I'm sure there are a lot of other pieces of fascinating abortion information tidbits):

Chapter 10 is on "Emergency Contraception". Note this: "Mode of action (some clients may need reassurance that emergency contraception is not an abortion)."

Chapter 11 is on "Diagnosis of Pregnancy": "In the event of pregnancy, determination of the gestational age is important to give the woman an estimated date of delivery. This determination is also useful in the diagnosis of certain pregnancy complications (e.g. ectopic pregnancy or threatened abortion). When a client is considering an abortion, information about gestational age helps the woman to make a decision, and where legal, is essential for selection of the appropriate technique."

Chapter 12: "Safe Abortion": "In circumstances where abortion is not against the law, health service providers should be trained and equipped to offer a safe and accessible service. Provision of, or referral for, abortion services is an essential part of women’s sexual and reproductive healthcare: fulfilment of a woman’s right to choice should be a high priority for such programmes. As with all sexual and reproductive health services, the client’s right to confidentiality and privacy must be sustained."

Chapter 13 is on "Options for unintended pregnancy":
"HIV does not necessarily have a negative impact on the pregnancy but might have an adverse effect on the health of the mother especially if her CD4 count is low and ARVs are not available. HIV also leads to increased rates of complications after delivery and is associated with an increase in maternal mortality. If the client is currently pregnant but does not wish to continue her pregnancy, she should be referred to safe abortion services, where legally permitted. Postpartum contraception should be offered as an option for those who do not wish to become pregnant again".

These paragraphs from the guide books, guide the IPPF people (or MAs) on how to refer for abortion, where legal. But when abortion is not legal, what kind of advice do the IPPF people give to their clients?

My next entry will disclose more information from the IPPF proposal.