The Foreign Service Journal, May 2022

THE FOREIGN SERVICE JOURNAL | MAY 2022 19 SPEAKING OUT On Our Own: Diplomats Deserve Equal Access to Reproductive Health Services BY ANDREA CAPE L LÁN Andrea Capellán has been a USAID Foreign Service officer for 10 years, serving as a contracting officer in Dakar, Senegal, Lima, Peru, and now in the Management Bureau’s Foreign Operations Division in Washington, D.C. Her onward assignment is as the supervisory contracting officer for USAID/Mexico. T his is the story of a group of women who have decided not to stay silent any longer, despite the shame, sadness, fear, anxiety and trauma we still feel in the aftermath of the experi- ences we share in the following. From fertility issues, missed miscar- riages and complications from unwanted pregnancies, to embryo reductions, endo- crinal therapies and menopause, women in the Foreign Service community have faced serious reproductive health–related medical concerns—not only without the support of the State Department Bureau of Medical Services (MED), but even as it actively and repeatedly forced patients into impossible decisions and significant financial burden, and put them in life- threatening situations. After weeks and months of deliberat- ing how to best advocate for change, the authors of this article sent a letter in December 2021 to Ambassador Carol Perez, then–acting under secretary for management and sent a copy to MED. The letter, viewable at bit.ly/HealthAtPost, calls for equal access to reproductive health services when at post overseas. As of late March, MED had not responded to this letter. How the Outcry Began It all started with a post on the FS Women Facebook group in which a Foreign Service officer assigned overseas asked if other women had faced chal- lenges accessing reproductive health care abroad. This woman had found out at four weeks of gestation that she had an unwanted pregnancy. After having prom- ised her immediate assistance, the health unit told her that her only option was to wait another two months to medevac for genetic counseling. Soon after that Facebook post, she made contact with another woman who, after receiving health unit–supported fer- tility treatments, was abandoned by that same unit when she needed a lifesaving embryo reduction. This woman scrambled to evacuate herself to receive the lifesaving treatment she needed. Once connected, the two learned about more women who had dealt with similar struggles. Over the past six months, this group has unleashed a wave of protest and solidarity, with dozens of women joining in. Their reports are more than just trou- bling and pervasive; they are, at times, horrific. They point to a systemic disregard for women’s health care and female-spe- cific needs by MED, a bureau currently led and managed by five men, and its mission health unit outposts. This lack of care remains despite the fact that 40 percent of our workforce consists of women (not including the family members of those serving under chief-of-mission authority overseas, for whomMED and its outposts are also tasked with providing care). FSOs Share Stories of Mistreatment and Trauma Because medical care is often a private matter—and evenmore so when dealing with reproductive health issues—many of those affected within our Foreign Service community have chosen to share their experiences only with close friends or family; some experiences are simply too traumatic to relive through retelling. For this reason, names have been changed in the paragraphs below and the complete list of drafters of the letter are not identified. Kina had tried to get pregnant for some time and used the health unit–approved doctor list to find a reputable OB/GYN to assist with fertility issues. Following treat- ment, she found out that she was carry- ing four embryos, which the doctor said would jeopardize her life and the survival of any of the embryos. To save her life and remaining embryos, the OB/GYN recom- mended an immediate embryo reduction no later than eight weeks of gestation. This procedure was not available locally. Despite a health insurance determi- nation that the embryo reduction was medically necessary immediately, MED refused to medevac her before 12 weeks. MED also refused to locate a provider to perform the procedure in the U.S., refused to schedule an appointment for the pro- cedure, refused to allow her to return to post after the procedure, and insisted on