Reading the teen favorite Are You There God? Its Me, Margaret, by Judy Blume, I first encountered the notion that young women were supposed to worry about their breast size. Margaret, the protagonist, fretted over her lack of development and devoted herself to breast enhancement exercises with the famous chant "I must, I must, I must increase my bust!" Well, there was no room for doubt. If I wanted to be seen as a maturing young woman then I, too, needed to want to increase my bust. So I sat down and mimicked the exercise described in the book every day for two months. It wasn't until I had the puberty talk with my mother that I realized biology, and not those quirky stretches, had begun to work its magic on my body.
But my breast awareness had really started years earlier, when I was scolded for playing outside without a shirt on. I was about four, it was summer and, for the first time, my mother went ballistic over my shirtless frolic in the sprinkler. The message was clear - boys could play without wearing shirts but girls had to hide our bodies. The message expanded when I began to develop noticeable breasts around the age of eleven.
I quickly learned that "good girls" wear bras so that they don't draw attention to their breasts and bad girls don't. Obviously, breasts were naughty and that idea took root when both my female and male peers began to mock my changing body. So I dutifully hooked on my first bra, un-tucked my shirt and tried to hide my growing breasts.
Even as I struggled to come to terms with my growing breast size, my favorite fashion magazines instructed me in the rules surrounding breasts. Cleavage was enticing when displayed on a date but inappropriate in a work-place setting. Jiggling was funny and sagging was a sign that a woman was losing her seductive appeal.
Somehow I emerged from my teens and learned to love my body, which includes a DD cup size, but it was a long personal journey won in spite of society's breast obsession. So, when I came across an article titled When Big Breasts Are a Big Pain, featuring the stories of a woman who had breast enhancement surgery to create the largest breasts in Brazil, and of a woman who opted for breast reduction surgery to address her physical pain associated with large breasts, I wanted to scream.
Large breasts can result in health problems. Back pain associated with large breasts is a real medical concern, and many women struggle with it. But let's keep it real - the pain associated with large breasts isn't always physical. Society still sends out those negative messages to women that breasts are sexual, large breasts are even sexier and "good girls" should be prepared to minimize or suffer the consequences. Some women want a larger breast size because they want to be "sexier" while other women with large breasts long for reduction surgery because they have had enough of being sexualized and told they should "celebrate" their large breasts. Lost in the conflict is a positive body image for many of us.
For some the solution to the
body image problem is breast positive activism. The website GoTopless.org promotes the philosophy that a woman
has a constitutional right to go topless in the same public places as
men. The site calls for a national "go topless" protest day in August -- though the movement may lose some of its credibility due to its affiliation with
the Raelian movement. GoTopless points out that women's bodies are
seen as legally offensive or too provocative for public display while
men are free to waltz about topless in many public places.
Still, I prefer the body positive
approach of neo-soul singer Jill Scott who has partnered with Ashley
Stewart stores to design a new plus size bra line. Scott provided designers with personal
feedback and insight during product development, instructing them on
the typical problems associated with finding a comfortable bra when
a woman is large of breast. The result is a much anticipated bra
line that features gel-padded shoulder straps and appropriate support
in fashionable designs that will hopefully go a long way towards alleviating
physical pain and a negative view of large breasts.
June is LGBT Pride Month and, along with the festivals and parades, we have an opportunity to learn about the diversity within our community and the issues that impact the lives of LGBT people. For many transgender people, the process of transitioning is a long and expensive journey delayed due to the lack of health insurance coverage for medically necessary procedures.
First, a quick primer. "Transgender" describes the state of a person's gender identity, which may match their assigned at birth. Other words transgender people may use are female to male (FTM), male to female (MTF), and genderqueer. After coming out, transgender people may undergo psychological counseling for diagnosis, hormone replacement therapy (HRT) to adjust their body to their new gender, medical visits to support that therapy, and sex reassignment surgery (SRS) to change their genitals to match their new gender role. Through sex reassignment surgery, transgender women may undergo a penectomy and vaginaplasty. Transgender men may undergo bilateral mastectomy and hysterectomy and, in some cases, they may also elect phalloplasty (construction of a penis).
These procedures cost thousands of dollars and they are not optional for many transgender people. Most states require medical procedures before personal documentation, like drivers licenses and birth certificates, can be updated to reflect a person's new gender. But, despite those requirements, many insurance policies do not cover sex reassignment surgery, which is often considered cosmetic or not medically necessary. Thus transgender people must pay thousands of dollars out of pocket even if they have health insurance coverage that would cover the surgical procedure for a medically recognized condition.
Transgender people may also consider cosmetic surgery in order to adjust their appearance to their new sex role. Cosmetic surgery procedures may include breast augmentation or facial or torso surgery, and transgender women may require electrolysis to remove hair. Many insurance companies do not cover these procedures for any participant in their plan because they are considered elective or not medically required.
Why would a health insurance plan not cover a surgical procedure for a transgender person? The American Psychological Association's current classification of gender identity disorder (the diagnosis given some transgender people that may allow them to qualify for sex reassignment surgery) as a psychological disorder does not clearly support medical treatment through sex reassignment surgery. As a result of the current lack of clarity, many insurance companies discriminate against transgender people seeking coverage for the cost of surgery even if the company through which they are insured approves coverage.
Transgender activists have been working to get an official
diagnosis and classification for Gender Identity Disorder from the American
Psychological Association to address the need for medical care and appropriate
mental health care for transgender people. In 2005, the American Psychological Association formed a task force
to study gender identity and they have been reviewing the scientific
research and American Psychological Association's policies with the
goal of developing recommendations for education, training, practice
and additional research. The completed report is scheduled for
presentation to the American Psychological Association's governing
Council of Representatives in August 2008.
Transgender activists
are divided over
whether the classification of gender identity disorder from the American
Psychological Association as a mental disorder is positive or negative,
with some feeling that the classification stigmatizes transgender people
and others arguing that the classification is necessary to secure appropriate
health care and treatment. What is not in dispute is the need
to address lack of access to treatment options and the discrimination
many transgender people face within society and the medical community.
In 2007, the American Medical Association amended their nondiscrimination policies to include transgender people. As reported by the Windy City Times, the policy change "affects all aspects of the functioning of the AMA, including relations with patients, employment issues and insurance coverage." The report also noted that transgender people face discrimination within the health care system and barriers that prevent access to health care. In one section of the new policy the American Medical Association clearly states its opposition to "the denial of health insurance on the basis of sexual orientation or gender identity."
As companies, health care insurers and municipalities examine and revise their policies to ensure that transgender people are not discriminated against or denied access to medically necessary treatment, the cost of sex reassignment surgery remains an obstacle for many transgender people seeking transition into the sex role that better reflects their identity. As our community celebrates LGBT Pride Month this June, we can celebrate the progress made within the medical and psychological communities. But we must also note the progress yet to be made and the impact of that lack of progress on the lives of transgender people. ]]>
When a 2005 Center for Diseases
Control study of 15 to 19 year olds reported that one in four teen virgins
had engaged in oral sex, public response was intense -- to say the least.
Many news outlets reported that teens were engaging in oral sex so that
they could claim that they were still technically virgins, while talk
shows warned of teens casually engaging in oral sex at parties with
multiple partners. Some speculated that the apparent
rise in oral sex among teens was the result of the Clinton political
scandal that put into question whether oral sex was really sex. Others wondered whether teens
chose oral sex over vaginal or anal intercourse in response to a fear
of pregnancy and/or sexually transmitted infections.
The teens I work with constantly remind me that teen attitudes towards sex have changed since I was their age. A class doesn't go by without my students responding to something I say with a good-natured eye roll and an explanation of how folks "do it different now" or "don't think that way anymore." My students are teen mothers or pregnant teens and we discuss sex openly during our women's health classes. Even so, I was surprised in 2005 when the CDC's findings appeared to indicate that teens were engaging in oral sex because they didn't define it as sex and as an alternative to sexual intercourse. My student's didn't share that they thought oral sex wasn't sex or that is was an alternative to sexual intercourse. Instead, they spoke of oral sex as part of a sexual relationship or part of sexual exploration.
But the results of the CDC study released in 2005 suggested that more than half of those teens surveyed responded that they were engaging in oral sex. Although researchers did not ask about the circumstances in which oral sex was taking place, many people interpreted the data to mean that teens were engaging in oral sex because they did not view it as sex and felt that oral sex was a way to remain "technical virgins." In other words, the study claimed that one in four teens was using oral sex as a substitute for sexual intercourse. Could it be that teens were responding to abstinence-only curricula by opting for oral sex over intercourse? Or was it that teens were avoiding sexual intercourse because of lack of access to contraception? Was this apparent teen oral sex epidemic a good thing or a bad thing?
Well, it turns out that all
the speculation was likely in vain. A new study from the Guttmacher
Institute challenges the facts of and conclusions drawn from that 2005
CDC report. As reported by Amie Newman in Teen Myth Busting:
Study Shows Oral Sex No Substitute For Vaginal Intercourse, the Guttmacher report found that the
conclusion that teens frequently substitute oral sex for sexual intercourse
is flawed - oral and anal sex are significantly more common
among teens who have already had vaginal intercourse than among those
who have not. In other words, teens are more likely to
explore a range of sexual activities as they become sexually active
and are not likely to substitute one activity for another.
Now that we know that teens aren't using oral sex as a substitute for sexual intercourse and that they are engaging in a variety of sexual activities when they become sexually active, we must use this new data clarifying teen sexual behavior to address the increase in teen sexually transmitted infection and re-infection rates. The challenge is to work with the reality of teen sexual behavior rather than speculate over the myth of technical virginity.
For direction we can look to the example of programs like Sexual Awareness for Everyone (SAFE), which has had success in reducing STI re-infection rates among the high-risk teenage women of color participants in the program.
A study of the SAFE program conducted by Andrea Ries Thurman of the University of Texas Health Sciences Center-San Antonio and her colleagues followed a group of 14 to 18 year old black and Mexican-American participants. SAFE offers comprehensive STI counseling and education. Participants in the study attended small groups that included role-playing sessions, interactive video sessions, reviews of written material and group discussion that addressed strategies for prevention like abstinence and monogamy while explaining the importance of sticking to STI medication regimens as prescribed.
Graduates of SAFE are less likely to engage in high risk sexual behavior and have a lower incidence of recurrent gonorrhea and chlamydia as compared with teen women in a control group who received only 15 minutes of individual counseling. The cumulative STI re-infection rate for teen women who participated in SAFE was 24 percent, for the control group this number skyrocketed to 40 percent.
As Emily Douglas wrote in response to the data that one in four teen women have an STI, all four out of four teen girls need better sex education and better sex education requires a deeper understanding of the reality of teens and their lives. Reproductive justice activists who work with teens know that pro-knowledge programs built on solid data like SAFE help to address the real risks teens face when they are sexually active. Looking back, it is clear that the problem with the 2005 CDC teen oral sex study wasn't in the data but with the speculation that followed. Programs like SAFE and their undeniable success in reducing risk demonstrate that comprehensive sex education remains the key to empowering teens.
Sex education the Midwest Teen Sex Show style
]]>
Guadalupe Benitez of Oceanside,
California, went to a local medical practice that was covered by her
insurance to receive treatment for polycystic ovarian
syndrome.
In 1999, she was finally ready to attempt to get pregnant through artificial
insemination. That's when her doctors, citing religious objection to aiding lesbian parenthood, refused to perform the procedure. Benitez, now
36 and the mother of a 6-year-old boy and 2-year-old twin
girls, sued her doctors for discrimination based on sexual orientation.
Benitez alleges that her doctors
treated her with fertility drugs but refused to conduct the IVF procedure
saying that doing so for a lesbian patient went against their religious
beliefs. She also alleges that her doctors gave her instruction
on how to inseminate herself but refused to handle the procedure themselves.
Benitez's doctors, Christine Brody and Douglas Fenton, refused to
perform the IVF procedure for her in 2000. In 2001, Benitez she sued them,
claiming that they "violated a California state law that bars for-profit
businesses from 'arbitrarily' discriminating against clients
based on characteristics such as race, age and sexual orientation," the Daily Women's Health Policy Report notes.
Prior to 2000, the California Supreme Court had ruled that businesses
could not deny services based on sexual orientation but it did not rule
against discrimination based on a person's marital status until 2005.
In sworn declarations Benitez's attorneys said that her doctors stated that they refused her IVF based on their Christian beliefs, which they said prohibited them from providing the treatment to lesbians. However, in later depositions the doctors claimed that their beliefs prohibited them from providing the treatment to any unmarried couples regardless of their sexual orientation. Although a trial court ruled in favor of Benitez, that ruling was over turned by an appellate court, which noted that California civil rights law at the time did allow businesses to deny services based on a person's marital status. Now the case, which has been brought to address the issue of whether a doctor's religious views can be used as a defense for refusing treatment, is before the California Supreme Court with a ruling expected in the next 90 days.
Until 2005, women could be denied medical treatment for infertility in California because they were not married on the grounds that assisting them in getting pregnant was a sin. History reminds us that many women were refused prescriptions for the pill because they were not married. If the California Supreme Court rules that doctors may refused lesbians treatment based on their religious beliefs, would they also be allowed to use that defense to refuse treatment to people of color, people of a different faith or atheists?
Those questions should not be casually dismissed. The refusal of services based on religious grounds is a defense used by pharmacists who refuse to fill prescriptions throughout America. The National Women's Law Center reports that refusals to fill contraception or emergency contraception prescriptions by pharmacists are increasing nationwide. These refusals are particularly problematic in rural areas and for low-income patients who may not have other pharmacy options. The National Women's Law Center's Pharmacy Refusal Project works to address the problem of pharmacy refusals by developing legal approaches to secure the right to access contraception at the pharmacy and providing technical assistance for people who have been denied contraception.
It is important to note that there is a difference between the denial of IVF based on the patient's sexual orientation and the refusal to fill a prescription because of a religious objection to the purpose of the medication. The denial of IVF based on a patient's sexual orientation is a case of discrimination against an individual while the refusal to fill a prescription is based on a personal objection to the medication itself and/or the service requested, not the individual requesting that service. The Committee on Ethics of The American College of Obstetricians and Gynecologists (ACOG) addressed conscientious refusal in their November 2007 opinion titled The Limits of Conscientious Refusal in Reproductive Medicine. The abstract of the opinion explains that
...conscientious refusals should be limited if they constitute an imposition of religious or moral beliefs on patients, negatively affect a patient's health, are based on scientific misinformation, or create or reinforce racial or socioeconomic inequities. Conscientious refusals that conflict with patient well-being should be accommodated only if the primary duty to the patient can be fulfilled.
In the Benitez case, her doctors did not refuse to treat her after the initial consultation and then refer her to another physician. They treated her as their patient for quite some time and then refused her the IVF procedure because of who she is, and that is a deviation from the guidelines stressed in the ACOG opinion and the basis for the discrimination lawsuit.
The denial of medical services based on religious grounds is clearly a defense of discrimination that could impact all women. Guadalupe Benitez will soon find out the California Supreme Court's ruling in her case. Although she was able to find other medical treatment and she now has three children, Benitez says that the out of pocket costs were not covered by her insurance and that those costs were significant. I can't help but wonder how many other women and couples have faced the same situation and were not able to find or afford alternative treatment. How many patients across America were told that they are not worthy to be parents because of who they are and how many more would be at risk due to discrimination based on religious grounds if that legal defense becomes protected by law? Guadalupe Benitez's case is a reproductive justice battle that should remind us that there, but for the grace of legal protection, go all of us. ]]>But I wondered how low-income and poor people were able to afford infertility treatment when the cost is so high and coverage so limited. I know a lot of people who intend to have a baby but could not afford thousands of dollars if they were diagnosed with infertility and I imagine that they would be devastated. The desire to become a parent is not connected to an individual's ability to afford infertility treatments. Yet treatment for infertility remains prohibitively expensive to many women and couples.
In many
ways, access to and the affordability of infertility treatments speaks
to our society's view of who is considered worthy of motherhood.
Infertility is defined as the inability to conceive a child after attempting to do so over the course of 12 months, and it can affect men and women. Approximately 10 percent of the population will experience infertility, reflecting a diverse group of people representing all socioeconomic levels and backgrounds. There are many different causes of infertility. About one-third of all infertility cases can be attributed to males, another one-third to females and the remaining one-third to either a male or female condition or to an unidentifiable cause.
Coverage of infertility treatment
is usually limited
whether it is provided through public or private insurance. Many
insurance plans do not provide coverage for the more advanced and expensive
procedures or treatments and only one-quarter of states require private
plans to cover certain forms of infertility treatment with the specific
details of that mandated coverage varying widely from state to state.
Currently 15 states require insurance coverage for infertility treatments.
The result is that many
people are not able to treat infertility due to the high costs associated
with medical treatment and lack of adequate insurance coverage.
Some women have even taken to purchasing the drugs required
for some treatments online through the so-called "black market"
where fertility patients often sell left over medication at a discount
in an attempt to recoup some of their investment. Despite the
risk of purchasing counterfeit or potentially damaged medication, some
patients go online to cut treatment costs where they can. And some
doctors are concerned that women may be self-medicating without medical
supervision and thus putting their health at risk.
When I looked online for information about infertility coverage for low-income or poor women, I stumbled on a blog whose author stated, "I thought that the cure all for infertility was to just go on welfare. In no time you'll have one on each tit and another in the oven." The post mocked a pharmacy client on Medicaid who had requested a prescription be filled for a medication to treat infertility. The author was disgusted that anyone on public assistance would try to get pregnant and assumed that the client was trying to exploit the system. Many of the comments posted expressed the view that low-income people shouldn't be allowed to treat infertility because they wouldn't be able to provide for a child on their own. Other comments boldly claimed that society had the right to deny medical treatment for infertility to poor women because they were on public assistance.
Decades after eugenics was debunked and fell out of favor as a movement
to "improve society," the residue lingers: there is a strongly
held belief that pregnancy and income should be connected. President
Reagan tapped into that sentiment with his infamous comment about a "welfare queen," but the core belief is as old as
the American Dream: people who are poor are considered lazy, deserving
of poverty and undeserving of anything it takes money to buy.
Low-income women who are faced with infertility and seek treatment are
suspected of trying to work the system and defraud society.
The belief that low-income and poor people do not have the right to medical treatment for infertility is disturbing enough on its own but it is particularly disturbing when you add in the factor of time. A woman's ability to conceive and carry a pregnancy to term begins to decline significantly when she reaches her mid-thirties with that rate of decline accelerating as she enters her forties. The window of time in which a woman can successfully treat infertility leads many women to adjust priorities and pursue pregnancy despite their current economic status.
This election year, universal healthcare coverage is a key issue, but universal coverage for infertility treatments has not been part of the discussion even though infertility treatment remains economically out of reach for many who need it. As a reproductive justice issue, the right to choose is clearly being denied those seeking treatment for infertility. But the reproductive rights of low-income and poor people continue to be held hostage to the values of a society that associates money with a person's worthiness to receive medical treatment.
As some supporters of universal healthcare push for mandates that would require every American to be insured, the lack of clarity over what specifically will be covered leaves low-income and poor women vulnerable to the whims of those who feel pregnancy is a privilege reserved for some and denied to others. As a result, many people confronted with infertility will weigh their dream of becoming parents against the limits of their income and continue to face high costs and limited coverage even if universal healthcare becomes a reality in America. ]]>I am amazed by the dedication and commitment it takes for these young mothers to graduate from high school. One third of young women who drop out of high school cite pregnancy and/or motherhood as the reason. So educators have been exploring programs to help pregnant teens meet the demands of parenthood and while being a full time student. In recent years, special schools for pregnant students have been phased out in favor of mainstreaming those students in existing schools.
The young mothers I know are
experts on the system of social services and programs. They share
information with each other about Medicaid, food stamps, daycare, parenting
supports and transportation. A typical week revolves around city
bus rides, day care drop offs, feedings, diaper changes, study hall,
tests, classes and day care pick ups. They return home to balance
homework with parenting only to wake up and begin the routine again.
Each one of these young women wants to be a good mother. They know that they will be able to provide a better future for their family if they graduate from high school, but they also feel that, in many ways, school time is time away from their child. The present is at war with the future and time is as precious as gold.
When I read the recent Christian Science Monitor article by Ben Arnoldy Special Schools for Pregnant Girls?, I thought of the young women I have met. The article covers special schools for pregnant teens in Boise, Idaho, that are losing funding despite successful outcomes. It points out that the value of these special schools depends greatly on the services provided and that those vary by region and school system. As school systems across the country are opting to mainstream pregnant teens due to budget concerns and concerns over the quality of education at the special schools, the impact of that on graduation rates for teen parents remains unclear.
The Boise P school featured in the Monitor reported an 80 to 90 percent graduation rate and that 50 percent of graduates went on to attend college or junior college. But the article also cites a lack of national data on P school graduation rates versus mainstream graduation rates for pregnant students and there are no definitive national studies.
I decided to reach out to some
student parents for their take on special schools versus mainstreaming.
Stacey, a 20 year-old mother of two, attended a special high school for pregnant students or "P School" when she was pregnant with her first child. Stacey's first pregnancy was the result of a rape and she chose not to transfer to a P school.
"I was in therapy and it
seemed that everything about my life had changed after I was raped.
I just wanted to hold onto something from my life and going to the same
school felt normal. But everyone treated me differently even though
few knew about the rape. People just assumed that I had gotten
pregnant by choice or by being stupid. When I missed class because
of morning sickness my teachers didn't believe me and I wasn't able
to reschedule tests. My counselor at school was great and she
hooked me up with a lot of programs and Nurses for Newborns too. But I felt very isolated
and embarrassed. Support was there but I had to search it out
and that was a hard thing for me to do at the time."
Stacey dropped out after giving
birth to her first child. She missed a semester and didn't want
to return, but decided to return after discussing her options with her
therapist. Stacey returned to her mainstream school and struggled
to balance parenting with course work. When she found out she
was pregnant again, this pregnancy was the result of consensual sex
with her boyfriend, she was resigned to having to drop out again.
"Going to school with one baby was hard. There was no way I could do it with two! I was sure I had messed my life up for good and I went to my counselor to sign up for GED classed but she said there was a P school near where I live. I decided to give it a try but didn't really think going to a P school would be any easier."
Stacey, who graduated for high school and is now attending Community College, admits that the P school made all the difference. She was able to attend school and nurse between classes and she found the integration of skills classes into the curriculum helpful.
"The best part of the P school
was that teachers and students encouraged each other. And no one
expected me to drop out. Instead people expected me to take advantage
of the program and stay in school. So when I fussed about being
tired my teacher worked with me to adjust my schedule. When I
ran into trouble with day care people stepped in with advice.
And when I had my baby people where there to explain to me how I could
make it all work and finish school. I returned to a regular high
school and it was hard but I learned a lot about what I could do while
at the P school. I owe my diploma to those people."
But P schools are not the perfect solution to the problem of pregnant teen drop out rates. As Andrea Lynch has pointed out, the P schools that were closed by the New York City Department of Education at the end of the 2006-2007 school year had disproportionately low attendance (48%, compared to 89% citywide), poor test results (less than 10% of students passed a required Regents exam), and low rates of credit accumulation (the average P-school student accumulated 4-5 credits annually, significantly less than the 11 annual credits required to stay on track and graduate on time). More disturbing was the finding that may students reported that they were forced to attend P schools because counselors and administrators felt that they would be more comfortable. There was a concern that these students were being forced from mainstream schools because administrators were uncomfortable with their presence there and not for their emotional and educational benefit.
Lynch also explored grassroots groups that advocate for programs that support and provide quality educations for pregnant teens and teen mothers. These groups are built on a reproductive justice model that seeks to empower young mothers even as it challenges society and the education system to meet their needs.
Stacey intends to take up that
challenge when she graduates from college with a degree in social work.
"Everyone has the right to an education and the right to choose to be a parent or not. I made my choice and found my right to an education somewhat limited. Too much of my story is about luck and it should be about design. If I hadn't graduated it wouldn't have been good for my family and future or my community. When I get my college degree I'm going to work on this."
With one third of young women citing pregnancy as the reason they dropped out of high school Stacey's help will be needed. Since some programs like the Boise P school report success while other programs like those in New York City found major achievement gaps, research is needed into these programs to improve upon what works and phase out what doesn't. Evaluating the success of P schools versus mainstreaming pregnant students is a start. The National Women's Law Center is lobbying Congress to amend No Child Left Behind so that it will allow for the collection of data on pregnant students and the Healthy Teen Network is heading up a three year study to determine if P school programs with high graduation rates are also providing students with good academics. These studies will assist in determining the academic value of P schools.
What is also needed is a commitment to provide more support opportunities for young parents and fund programs that we know are working. If school systems phase out P schools they must replace them with comprehensive programs that assist student parents. A lack of support programs does not serve as a misery-based deterrent to teen pregnancy, but rather is a recipe for increasing an already daunting drop out rate.
]]>Incidents like this do not happen often but they could happen anywhere. Following the infant's discovery, the media has been exploring the angles from the police department's search for the mother to the flood of prospective adoptive parents contacting child welfare officials. Outraged listeners are calling in to local talk radio stations questioning what kind of woman would leave her infant in a dumpster. They're even more outraged when they discover that Missouri has a Safe Haven, or "baby Moses," law that states that an unharmed newborn, up to 30 days old, may be relinquished to personnel at any medical facility, fire department or police department without punishment for the mother and without automatic termination of parental rights. All states have some version of this Safe Haven or baby Moses law.
This woman had options, many callers say. She could have dropped the baby off at the hospital instead of a dumpster.
My first reaction to this story was concern for the infant and the mother. The newborn is recovering at St. Louis Children's Hospital but the mother has yet to be identified. A person of interest has been identified on surveillance video and witnesses place a woman with blood on her clothing in the vicinity of the dumpster in which the baby was found. Authorities point out that, having recently given birth, the mother may be in need of medical attention too.
Curiosity quickly joined my
concern. I volunteer with pregnant teens and young mothers at
shelters and yet I was unfamiliar with the specifics of our safe haven law.
On the surface, the law appears to do exactly what the title states:
provide a safe place for newborns and an option other than abandonment
on a doorstep or in a dumpster. But if people only hear about the law
when news of an abandoned baby breaks, how significant an impact can the law possibly
have and what, if anything, is being done to address the underlying reasons why
a woman may find herself needing to give up her baby?
I know from my volunteer experience
at emergency shelters that finding a shelter placement is hard. There
are long waiting lists at shelters -- not nearly enough shelters -- for pregnant women and new mothers facing domestic violence or
unfit home situations. And I also know that the safe haven law
is not well publicized, nor are the designated locations.
Yet the benefits of the Safe Haven law seem clear to an outraged public. If a woman finds herself in a desperate situation she can simply go to a designated safe haven and leave her baby, no questions asked. Instead it appears that a woman gave birth alone and then abandoned the infant to a city dumpster. She didn't take advantage of the Safe Haven law and, to many people, that makes her a monster.
Lynn Paltrow, Executive Director of National Advocates for Pregnant Women (NAPW), says that while anything that provides an alternative to punishment is good, Safe Haven laws are necessary because our government is failing its responsibilities to provide for the health and well being of women and families.
"In a sense it seems that these laws become the substitute for universal health care and comprehensive sex education," Paltrow says. "The government won't provide universal health care -- that includes contraception, prenatal care, mental health services, and abortion -- so that women might not need to drop their babies off at fire houses. Moreover, the government funds abstinence-only, shame-based sex education rather than comprehensive sex education that would help prevent unplanned pregnancies and reduce the shame associated with them -- so women might not feel their only option is leaving a child with the local firefighters."
Paltrow points to the fact that Safe Haven or "baby Moses" laws are used to argue against abortion rights. In arguments made on behalf of Jane Roe/Norma McCorvey, when she partnered with anti-abortion groups in an effort to overturn Roe v. Wade, one brief argued that abortion no longer needed to be legal because the burden of unwanted motherhood no longer exists.
"The brief makes it seem that Texas, with its appallingly bad record for providing poor children with health care, with hundreds if not thousands of children languishing in foster care -- will somehow become the great soviet lone-star state that will raise women's children for them," says Paltrow.
Paltrow warns that in South
Carolina, the one state that permits prosecution of pregnant women who
even risk harm to their viable unborn children, women who take advantage
of the Baby Moses law may still be arrested.
I immediately thought about the women in my family, so I sent out an e-mail blast with the information and my advice that my aunts have a chat with their doctor. I just assumed that all women were subject to the risks of hormone replacement therapy and that all women would be candidates for a reduction in risk by not taking that treatment option.
I was wrong. A recent study reports that stopping hormone replacement therapy does not reduce the risk of breast cancer for African American women. Researchers from the University of Chicago Medical Center found that the decline in breast cancer rates in American women over the age of 50 during 2002 and 2003 was limited to Caucasian women. Figuring out what that means and what to do with that information isn't easy. Breast cancer is complex and a person's background factors in to their individual risk. Understanding how breast cancer affects different populations is key to lowering risk, increasing early detection and survival. So we should welcome new research that highlights the different ways breast cancer affects African American women.
Last year Science Daily reported on a Kimmel Cancer Center at Jefferson in Philadelphia study that found that African American women are diagnosed with breast cancer later than Caucasian women and, when diagnosed, often have a more aggressive type of breast cancer and a poorer prognosis. African American women have a lower incidence of breast cancer than Caucasian women, but are more likely to die as a result of the disease and that gap is widening. Research points to a lack of access to healthcare being a strong factor contributing to disparities in both rates and outcomes, but biology also plays a key role.
Earlier this year, Science Daily reported that researchers are looking into whether breast cancer rates in African American women are connected to the conditions in our neighborhoods. Researchers at the University of Chicago are exploring the possible connection between disadvantaged communities and early onset breast cancer. Beyond the lack of access to affordable and dependable healthcare there is also the stress of struggling to survive in disadvantaged neighborhoods and dealing with crime, depression and lack of nutritional options. Researchers hope to be able to assist policy makers in developing plans that will address these factors and thus reduce risk.
And now there is the recent news that stopping hormone replacement therapy did not reduce the risk of breast cancer for African American women. A deeper look finds that the lack of decline may be related to the fact that African American women are less likely to use hormone replacement therapy so they didn't suffer the increased risk associated with HRT nor did they benefit from the stopping the treatment. Biology also plays a key role as close to 80 percent of breast cancers in Caucasian women are estrogen receptor positive and depend on estrogen to grow while only 60 percent were found to be estrogen receptor positive in African American women. This study is not a green light for African American women to resume hormone replacement therapy and all women should discuss treatment options and risks with their doctor.
All of these studies point to the need for increased breast cancer awareness in the African American community. We need to share information about early detection and screening options. We need to protect and defend clinics that are often the only source of well-woman health screenings for low-income women of color even as we support increased access to affordable healthcare for all. We need to educate ourselves and our communities and friends about the specific and unique risk factors associated with breast cancer and African American women.
The medical community should also use the results of these studies to examine how they are conducting research. Biology plays a role and researchers need to be mindful of the race and ethnicity of their subjects and avoid making conclusions about all women when there may be radically different result for certain populations. Funding for population specific research is needed so that researchers can accurately tackle complex medical mysteries rather than resort to a one size fits all strategy that may leave women of color out in the cold.
This news should inspire us to renew our commitment to promote early detection, access to treatment and to eventually find a cure for breast cancer. Because I want to see my fellow women of color join in the survivor procession at the next Race for the Cure.
]]>It must be spring!
The Missouri House has approved House Bill 1831, which "changes the laws regarding the consent requirements for obtaining an abortion and creates the crime of coercing an abortion." As a Missouri native my initial reaction was to ask what this bill was in response to. I haven't noticed a flood of news stories about coerced abortions here and pro-choice is the antithesis of coercion. But, true to form, this bill is not in response to a rash of complaints by women who have been coerced into an abortion. Rather, House Bill 1831 (Senate Bill 1058) is about devaluing the intelligence of women and questioning our ability to make decisions about our medical care.
In the mythical Missouri represented in House Bill 1831, women are fragile gullible creatures that need to be protected from manipulative forces that seek for us to have an abortion we don't really want to have. Under the provisions of the bill a man who asks his partner to have an abortion is guilty of coercion even if his partner was not actually pregnant and never actually had an abortion. A business would be guilty of coercion simply for threatening to reduce a pregnant employees pay and/or cut that employee's benefits. Oh but wait, it gets better! A business would also be guilty of coercion for threatening to terminate the employment of a pregnant employee.
Under House Bill 1831 schools would risk prosecution for coercion simply by threatening to revoke a pregnant woman's scholarship. Terminating a pregnancy resulting from rape would be considered coercion and physicians would face a felony charge for performing that abortion.
Pamela L. Sumners, Esq., Executive Director of NARAL Pro-Choice Missouri, points out that the House Bill 1831 recently approved by the Missouri House was much better than what was originally proposed.
"Believe it or not, this bill is so much better than it was when first it was introduced. It made leaving or even attempting to leave one's pregnant wife because she did not want to have an abortion a crime, ditto with threatening twice (but not just once!) to move out under these circumstances, or calling a lawyer about separation papers under these circumstances, or telling her you don't want to be a daddy so she better hit the road if she doesn't have an abortion."
Sumners added that NARAL Pro-Choice Missouri, Planned Parenthood, and domestic violence lobbyists worked very hard to strip the most constitutionally objectionable provisions from the bill.
"I want everyone to know how hard we work to keep the most utterly egregious provisions out of legislation. We still despise the glorious instrument you see today, of course. We do not like the premise of creating a crime of 'coercing' an abortion, although we at NARAL, like any other people of good taste and right reason, abhor the notion of coercion. We simply think that battery, assault, and stalking laws would adequately address any legally actionable "coercion" in this context."
House Bill 1831 (Senate Bill 1058) remains horribly flawed. The bill imposes personal investigative requirements on doctors requiring that they ascertain whether a patient seeking abortion services has an athletic scholarship that may be revoked or if she has been told her job will be negatively impacted if she is pregnant. A physician who fails to meet these investigative requirements will have committed a Class C felony.
What I find most alarming about House Bill 1831 is the creation of the crime of coercion. I can not imagine how this law would be enforced or how the legal system would determine that the law had been violated beyond a reasonable doubt. Add in the potential of false accusations and this mess just gets messier.
The Missouri Senate will soon take their version, Senate Bill 1058, under consideration. Given all that is wrong with this legislation, Missouri Senators should take this opportunity to lead by example and put an end to this insulting and unconstitutional nonsense.
]]>One of the birthing options many people consider is whether to use a midwife and, as Barbara Kantrowitz and Pat Wingret pointed out in their Newsweek piece The Delivery Debate, making that decision can be very confusing. Beyond the basic medical and personal considerations, some states are debating legislation that may impact access to midwifery care. Here in Missouri, State Senate has been debating Senate Bill 1021, which "changes the laws regarding midwives and the practice of midwifery." The debate over whether to regulate midwifery, how that regulation would take place, and which body would oversee that regulation has been fierce.
Currently, Missouri midwives must have a nursing degree and work under a doctor's supervision -- otherwise, they are committing a felony by overseeing the care of a pregnant patient. But Senate Bill 1021 would
"create a 'Board of Direct-Entry Midwives' [midwives who begin their education in midwifery directly rather than after completing a nursing program] within the Division of Professional Registration. The board shall have the power to issue licenses and to suspend, revoke or deny the license of a direct-entry midwife. The board shall develop practice guidelines regarding the practice of midwifery established by the National Association of Certified Professional Midwives, including the development of collaborative relationships with other healthcare practitioners who can provide care outside the scope of midwifery when necessary."
Steff Hedenkamp of The Big Push for Midwives Campaign, a group pushing for the regulation and licensure of Certified Professional Midwives in all 50 states and the District of Columbia, was in Jefferson City, Missouri, during the recent Senate debate. Hedenkamp said that she talked to a lot of Senators and Representatives who support Senate Bill 1021 because they like the compromises made and the way it will address concerns about liability, education, certification and licensing.The bill passed out of committee five to one which is proof, according to Hedenkamp, that there is political will to pass it if it were brought to the floor for an up-or-down vote.
Protecting and defending the ability of certified midwives to provide legal and safe healthcare is an essential part of the reproductive justice movement, as Amie Newman explored in her article A New Life For Midwifery Care. Amie argues that "restricting access to a full-range of health care providers, especially those known to improve health outcomes for maternal and newborn health, is not healthy for women and babies."
Yet those opposed to legislation like Missouri's Senate Bill 1021 claim that protecting maternal and newborn health is also their motivation. As reported by Michelle Munz of the St. Louis Post-Dispatch, the Missouri State Medical Association is lobbying for greater doctor supervision of midwives, stating a concern for public safety.
The group wants midwives to have written collaborative-practice agreements with a physician that will justify regulation by the Board of Healing Arts. An amendment proposed by Senator Graham, D-Columbia, would place the regulation of midwives under that physician registration board. But 24 other states license midwives and the majority of them do so without physician involvement with direct-entry midwives, instead licensing and certifying them through midwifery boards or committees.
Advocates for Senate Bill 1021 point out that regulating midwifery through the Board of Healing Arts would set a dangerous precedent of having one profession regulate another. Hedenkamp feels that the Graham amendment guts the bill and that the physician-based board would simply not issue licenses, effectively regulating midwives out of existence.
As things currently stand, Senate Bill 1021 may not go to the floor for an up-or-down vote. But midwifery advocates pledge to continue the fight. Hedenkamp says that "we will continue to work hard, continue to tell our stories, continue to shine light on and give voice to what Missouri families want: legal access to licensed Certified Professional Midwives in the state, and now."
]]>Among other things, the session explored the lives of the people caught up in the immigration policy debate and how the heated rhetoric has sparked fear and concern in many who have recently immigrated to this country regardless of their legal status.
I returned home from WAM! to St. Louis and saw my city with through new eyes. I have always found pride in the multi-cultural history of St. Louis where French, German, Irish, Italian, Chinese and most recently Bosnian immigrants settled. As the descendent of Africans who came to this land in bondage in the 1700s I do not claim an immigrant ancestry but I still identify with being the other trying to balance cultural identity with the American demand to conform.
I grew up celebrating my neighbors various American identities at Oktoberfest, St. Patrick's Day and Mardi Gras festivals knowing that many would join my community to celebrate Black History Month. Now, I wonder who will attend the Cinco de Mayo festival next month and whether it will be a celebration or an opportunity for a public demonstration of anti-immigrant bigotry because the immigration reform debate has become an anti-immigrant campaign fueled by fear with confusion and hatred its principle products.
For example, I recently overheard a conversation between two Somali women at a local shop. There are quite a few Somali families in my neighborhood and I've become familiar with the accent. While waiting in line one of the women anxiously asked the other to accompany her when she went to get her driver's license. The other woman assured her that she had nothing to worry about since she had legal documentation but her companion was unconvinced saying that "they" hate "us" now and she wanted someone with her just in case they tried to take her away.
The immigration discussion from WAM! was still fresh in mind and intellectually I knew that the debate has taken a toll but hearing that woman express doubt even though she had legal documentation floored me. I was embarrassed that the immigration reform debate has become so laden with anti-immigrant sentiment that fears of harassment may very well be justified in my city.
The Missouri House recently passed its omnibus illegal immigration bill just a week after the Missouri Senate passed its own version. The House bill requires Missouri State Troopers to be trained to enforce federal immigration laws, bars state grants to sanctuary cities, and requires that commercial driver's license tests be given in English.
This bill feels threatening to me, so I can not imagine how this legislation is being received by immigrants in Missouri. I empathize with the fear of being pulled over on a dark highway by a Missouri State Trooper and being asked to prove that I have the right to be where I have the right to be. I certainly empathize with the Somali woman's fear of harassment while getting her driver's license--my parents faced similar fears when they registered to vote in the 1960s.
In her piece The Third Rail: Reproductive Health Needs of Immigrant Women Aishia Glasford rightly stated that "How we treat the most vulnerable individuals, undocumented immigrant women and their children, is a reflection of the ethical and moral compass of our society."
The impact of anti-immigration policies on women is clear and reflects poorly upon our society. The Center for American Progress piece (Just the Facts: Immigration and Reproductive Justice) points out that anti-immigrant policies create barriers to immigrant women's healthcare and put lives at risk. In this current hostile environment where seeking a driver's license is seen as risky, seeking healthcare is being weighed against those same false risks even as access to healthcare is held back as the legal reward of time spent documented. The impact on our communities is unfolding and we must be mindful of what is happening in our own backyard and how it is re-shaping who we are.
When I look at the Missouri anti-immigration legislation I see fear mixed with bigotry reflected back at me and a state government willing to perpetuate all of that despite the damage it will do to our communities, the stigma it casts upon all immigrants and the additional barriers it erects that all but scream that immigrants are not welcome in communities that used to celebrate our diverse heritage.
I do not feel safer. I just feel embarrassed even as I wonder if that Somali woman ever went to get her driver's license and worry that she was harassed while doing so.
]]>When the news reported the findings of a study by the Editorial Projects in Education Research Center that only 70% of American students graduate from high school, I wasn't surprised. I thought about the young woman I know and how hard it is for her to balance parenting and education. But the study's findings were front page news, inspiring speculation over why students would drop out rather than complete their schooling given the undeniable fact that making a living wage without a diploma is damn near impossible.
But there was another study released last year that provides insight into the reasons behind the high drop out rate and the costs young people pay for not finishing their education. When Girls Don't Graduate, We All Fail: A Call to Improve High School Graduation Rates for Girls, a study released in October of 2007 by the National Women's Law Center, found that girls are dropping out at nearly the same rate as boys but are paying a higher cost for that decision.
The study found that nearly half of the dropouts from the Class of 2007 were young women. In 2004, 25 percent of female students dropped out. Women of color reported even higher rates with 37 percent of Hispanic, 40 percent of Black and 50 percent of American Indian or Alaskan Native female students failing to graduate in four years.
Young women that drop out of high school will earn significantly lower wages than male dropouts. These young women are at greater risk of being unemployed and being dependent on public programs. According to When Girls Don't Graduate the wage gap between men and women is highest among high school dropouts with young women earning 63 percent of male earnings.
These lower wages often translate into women without high school diplomas living below the federal poverty line on an average of $15,500 per year. These women are more likely to rely on Medicaid assistance and other public programs and they are particularly vulnerable to lack of access to healthcare.
When Girls Don't Graduate also addresses why young women are at risk for dropping out of high school, pointing to a survey sponsored by the Gates Foundation that reported contributing factors include a lack of family support, sexual harassment, bullying, and attitudes toward education. The Gates Foundation survey also found that the one-third of female dropouts reported that becoming a parent played a significant role in their failure to complete their high school education.
Clearly there is a need for schools to provide support for pregnant and parenting students. The Gates Foundation survey found that group was "most likely to say they would have worked harder if their schools had demanded more of them and provided the necessary support."
That is certainly the case for the young woman I know who is at risk of dropping out. She attends a public high school with daycare, but must provide for additional daycare outside of school in order to work. Her days are the very definition of struggle, filled with a never ending juggling act that includes school, parenting, work and navigating the public assistance system.
But this data also speaks to the desperate need for comprehensive sex education in all schools. Research shows that comprehensive sex education results in a multitude of positive outcomes including delaying becoming sexually active, reducing the frequency of sex and the number of partners, reducing instances of unprotected sex, and increasing the use of condoms and contraception when sexually active. Long-term outcomes include lower STI and pregnancy rates.
The numbers of young women who have dropped out are in need of affordable healthcare. Clinic defense is a defense of their right to screenings, testing and the variety of reproductive healthcare all people deserve in America.
The young woman I know will wake up tomorrow and begin her day making the choice of whether to push on or drop out. She will have a mentor to rely on for advice and encouragement and she has found an affordable clinic for birth control. But the choice will remain on the table until she walks across a stage and receives a diploma that will represent the difference between poverty and getting by.
]]>2,319,258 people are incarcerated in America. The staggering reality is that 1 in 100 adults are in prison. A Pew Center on the States report found that, although men are still ten times more likely to be in jail, the numbers of incarcerated women are growing at a faster pace. Among women ages 35-39 years old, one in 265 are incarcerated. The racial break-down in that age group shows that one in 355 are white women, one in 297 are Hispanic women and one in 100 are black women.
Within these numbers are mothers, sisters, daughters and friends all facing the variety of reproductive health issues any woman "on the outside" may face. The only difference is that they face them while incarcerated with prison policies being weighed against their reproductive rights.
In her article Women in Prison, Pam Adams explores the work of psychologist Susan George, who studied the impact of incarceration on Illinois families. The article points out that the number of Illinois women incarcerated has nearly tripled in a decade, with many of those arrested as a result of incidents related to drug addiction and poverty, and with histories of sexual abuse and physical abuse. Many women had parents who were incarcerated and children of incarcerated parents are five times more likely to go to jail.
Mentor programs like Amachi Pittsburgh attempt to break the cycle of multi-generation incarceration. Amachi, modeled after Big Brothers Big Sisters with a target of children ages 4 to 18, is a faith-based program that partners with local churches to match at risk children with mentors; the goal being to break the cycle where the children of incarcerated adults become incarcerated adults themselves. Though the mentor programs have seen success, communities and families are still paying the price for America's reluctance to fight the war on poverty, reform drug policies and support risk reduction programs with the same passion shown the building of new prisons.
Among the women arrested for drug related offenses, drug addicted pregnant women are also targeted for incarceration based on drug use during pregnancy. In 2007 I was privileged to blog the National Advocates for Pregnant Women (NAPW) Summit and hear the stories of women who have faced incarceration for using drugs during pregnancy. NAPW "seeks to protect the rights and human dignity of all women, particularly pregnant and parenting women and those who are most vulnerable including low income women, women of color, and drug-using women". Through their work NAPW gives a voice to women who are targeted for arrest and prosecution because of addiction and shines a light on the need for sane drug policies, affordable and quality healthcare and treatment options for pregnant women.
Women who continue their pregnancies behind bars face the challenge of poor nutrition, stress and the prospect of parenting from prison. Amie Newman's article Pregnant Behind Bars: The Prison Doula Project highlighted the work of The Birth Attendants who provide doulas to assist pregnant inmates. The doulas provide physical, emotional and psychological support before, during and after the birth of the baby. The article points out that some women are shackled during childbirth and that there are few resources available for keeping mother and child together after birth.
As activists we are constantly challenged to look beyond our world and connect studies with reality and policy to communities. One challenge before us is to vigilantly defend the reproductive rights of incarcerated women who remain vulnerable to the denial of access to abortion services. We are also challenged to include youth at risk due to the incarceration of a parent in our struggle. These young people need us to be mentors, participate in community programs and continue to demand the empowerment of comprehensive sex education.
Our struggle for reproductive freedom is key to the social justice movement and it must include the women within the one in 100 adults incarcerated in America.
]]>My volunteer experience began as a member of a woman's group in St. Louis, Missouri, that partnered with local woman's shelters to teach life-skills and health classes. After extensive training, I was matched with a class and I was thrilled to have the opportunity to volunteer at a transitional shelter for pregnant teens. I walked into the shelter with a well-planned lecture on the benefits of basic budgeting and walked out knowing that we needed to add comprehensive sex education to our curriculum fast.
That first class started out with a brief overview of traditional money management methods that quickly shifted to a discussion of the challenges of managing money when you are a teenage mother. It was a great discussion, so I decided to hang out after class and several students remained to ask me more questions. The teens chatted about how hard it is to balance school, work and parenting. Then the discussion turned to sex, pregnancy and prevention, in that order -- because that was the order they had experienced these in.
I'll never forget a fifteen year old mother-to-be telling me that she had thought drinking a certain caffeinated soda following unprotected sex would prevent pregnancy and I'll never forget her shy embarrassment when confessing that she still wasn't sure how her pregnancy happened. Through my work I have met young women who didn't know why they menstruated, thought they could tell by looking if a partner had AIDS and more than one who thought soaking in a bleach bath would prevent pregnancy or even HIV transmission.
Through my teaching, the disconnect between the policy debate over abstinence-only programs and the reality of young women's lives has been revealed. On one side, proponents of abstinence-only programs claim that they are working, while on the other side, the teen STI infection rate in St. Louis city is the highest in the nation. On the front lines healthcare providers and volunteers like me meet young women who learn prevention post-infection, who explore contraceptive options after a pregnancy and who are growing up in a culture where sophisticated media outlets sell sex as power and speculate over baby bumps -- yet sex education can now be summed up by Just Say No.
As Lynda Waddington pointed out in her article Missouri's Sex Ed Follow Federal Government Guidelines, Missouri law used to require that students be presented with "the latest medically factual information regarding both the possible side effects and health benefits of all forms of contraception, including the success and failure rates for the prevention of pregnancy and sexually transmitted diseases." Now, as a result of a ban against trained sex education teachers in the classroom and the addition of an opt-out option, the only groups allowed to teach sex education in Missouri are those that subscribe to abstinence-only guidelines.
St. Louis city is left to confront alarming increases in STD infection numbers among teens without award-winning trained sex education experts allowed access to them through the most reliable institution, their schools. The results of this flawed approach walk through the doors of local clinics and shelters for testing, treatment and education. If the teen is lucky, she walks out with her health. With HIV/AIDS infection rates on the rise, there is nothing pro-life about an education policy that increases the odds that the wages of sex will be disease and could be death.
While we struggle to educate in an anti-knowledge environment in Missouri, California just received a boon. The California State Board of Education recently adopted its first set of health education standards (K through 12) and they include a comprehensive sex education curriculum. California says that students should begin learning about risks and prevention in the fifth grade and that high schools should be required to teach students "medically accurate" information about birth control. There are still questions about implementation and parents may chose to opt-out, but such standards will empower California communities to proactively address sexual health and risk among teens.
The ban on award-winning sex education teachers and the promotion of an abstinence-only curriculum have made community outreach all the more important in Missouri. Community groups have joined with healthcare providers to increase the number of trained volunteers doing outreach. AIDS service organizations continue grassroots programs that encourage abstinence, prevention, testing and treatment. But as Emily Douglas so accurately pointed out, four out of four teen girls need better sex education.
From the frontlines it feels like we are fighting a relentless forest fire without water pressure. The news from California gives us hope that reinforcements may be on the way, but the question remains: how many teens will be put at risk while we wait for the return of knowledge to our classrooms?
]]>Hysterectomies are recommended to women who have medical conditions including cancer of the uterus, ovaries, or cervix. Fibroids, excessive bleeding and endometriosis are also conditions for which hysterectomy might be recommended and the procedure may also be recommended to women who have tried other treatments without success.
But why are doctors and researchers saying that as many as two-thirds of the hysterectomies performed in the United States were not necessary? Well, less invasive treatments are available that provide some women with choices other than hysterectomy. Endometrial ablation, myomectomy and robotic laparoscopic myomectomy are a few of the alternative treatments to hysterectomy.
Endometrial ablation is a procedure that destroys the uterine lining using a laser beam, heat, electricity or freezing. The uterine lining heals by scarring that usually reduces or stops uterine bleeding. Myomectomy is the surgical removal of fibroids from the uterus. Robotic laparoscopic myomectomy is a less invasive surgery to remove fibroids from the uterus.
With less invasive treatments available, why would unnecessary hysterectomies be so common? One answer is that some doctors recommend hysterectomy for various reasons such as the complications of myomectomy or additional medical factors for the individual patient. Another answer may be found between reading between the lines -- and that also happens to be where many uninsured and underinsured women fall.
A quick review of one common condition resulting in hysterectomy provides some insight. Fibroids are solid benign tumors on the outside, inside, or within the wall of the uterus. An estimated 30 percent of all women get fibroids by age thirty-five. Black women are more likely to have them and more likely to develop them at a younger age.
Many treatment options for fibroids depend on how early they are diagnosed and many women are first diagnosed with fibroids during a pelvic exam. Pelvic exams require medical visits and many women are unable to afford those appointments. Access to affordable dependable healthcare plays a large role in whether a woman is left with several options or few alternatives. And it is at that entry point where access meets coverage where some disturbing facts are found.
The number of underinsured Americans continues to grow as premiums rise and benefits are cut. Some 45 million Americans are uninsured and the women of that number are not getting access to cutting edge treatments or a variety of medical opinions.
The there is the issue of access to women's clinics. My fibroids were first diagnosed during my yearly exam at a Planned Parenthood clinic. When I later visited a gynecologist he harshly told me "it" was just going to have to come out. I was able to use my health insurance to change doctors and pursue less invasive treatments and eventually had a successful myomectomy. But the success of my treatment began when my fibroids were noticed during my pelvic exam at Planed Parenthood. As clinics continue to fight anti-choice efforts to shut them down they are fighting for the rights of all women to be empowered through dependable and affordable medical care.
The less invasive alternatives to hysterectomy require either money or solid insurance coverage. Early diagnosis of the conditions that often lead to hysterectomy is dependent upon access to affordable healthcare through dependable healthcare providers. The issue is not simply that there are new and less invasive options available, but that many women face an economic obstacle course that robs them of both time and opportunity.
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