Dr. Connie Mitchell is a nationally recognized expert on the health care of victims of violence and abuse. She serves on the AMA National Advisory Council on Violence and Abuse and is a member of the Board of Directors of Physicians for Reproductive Choice and Health.
I grew up as one of four daughters in a middle-class family. As sisters, we shared everything: bedroom, clothes, cars and double dates. It was a loving and lively home and one, I thought, of few secrets. But recently, after one of my sisters was killed in a tragic accident, another sister told me of the secret the two of them had kept for many years. At age 16, my deceased sister was pregnant and wanted to terminate the pregnancy. She sought the counsel and support of the sister now disclosing the story and got the reproductive health care she needed.
Later, I asked my mother about her reaction to the story, as I too was raising teenagers and would appreciate her perspective. My mother began to cry, but she quickly let me know that these were not tears about the abortion. Her tears flowed because the story made her feel so inadequate. She said, "I wish that I could ask her what I might have said or done differently so that she would know, really know, that I understood life provides challenges, that I loved her no matter what, and that I respected her as a young woman."
]]>Dr. Connie Mitchell is a nationally recognized expert on the health care of victims of violence and abuse. She serves on the AMA National Advisory Council on Violence and Abuse and is a member of the Board of Directors of Physicians for Reproductive Choice and Health.
I grew up as one of four daughters in a middle-class family. As sisters, we shared everything: bedroom, clothes, cars and double dates. It was a loving and lively home and one, I thought, of few secrets. But recently, after one of my sisters was killed in a tragic accident, another sister told me of the secret the two of them had kept for many years. At age 16, my deceased sister was pregnant and wanted to terminate the pregnancy. She sought the counsel and support of the sister now disclosing the story and got the reproductive health care she needed.
Later, I asked my mother about her reaction to the story, as I too was raising teenagers and would appreciate her perspective. My mother began to cry, but she quickly let me know that these were not tears about the abortion. Her tears flowed because the story made her feel so inadequate. She said, "I wish that I could ask her what I might have said or done differently so that she would know, really know, that I understood life provides challenges, that I loved her no matter what, and that I respected her as a young woman."
My mother and I went on to talk about adolescent sexuality and how puberty is a time when children become more private and begin to separate as individuals. She spoke of adolescent development and both the pride and anxiety a mother feels as she watches her child grow, make friends, date, hold hands or experience a first kiss. She asked, "How do you teach children that intimacy is essential to a full life and then expect that this lesson will be internalized without any trials or glitches?" Then she became more emphatic in her tone, signaling her intergenerational message. "The urge to protect your children is so strong that it can easily be twisted into a desire to control. Bearing your children and letting them go into the world is like two birthings, one that is physical and one that is mental, both painful and exhausting at times."
After a pause, I saw that she was crying again and in a softer voice she said, "As much as I wish she had come to me, I will be forever indebted to all those who made sure that she could get the medical care she needed and that she didn't have to be alone. I am so grateful that her older sister could help her and that well-trained, licensed physicians could perform the procedure so she could be safe and healthy and enjoy many wonderful years of her life."
My sister went to college, married a handsome man, had three wonderful children and traveled the world as a flight attendant. I coached her through the birth of her first son just as she coached me through mine. I miss her dearly.
Like my mother, I too wish I could have one more conversation with my sister. I wish I could tell her that her life was no different than that of any other woman. We are sexual, sensual beings and we have complex reproductive lives as we try to deal with major physical changes in our bodies throughout our lifespan. I would tell her that we are fortunate to live in an age where we have choices in partners, contraception, child rearing and medical care. The vast majority of women make these choices carefully, with great deliberation. And I would tell her that I will do everything I can to be sure that all women - young and old, rich and poor, with family support or without, regardless of geography, race or religion - have the same choices so that they can have the same opportunities and pleasures that we had.
My sister's story is the reason I am voting NO on California's Proposition 85. I know the women in my family stand with me in opposing an initiative that only blocks vulnerable young women from the reproductive healthcare and support they need. Please join me November 7 and vote NO on Prop. 85.
]]>Dr. Connie Mitchell is a nationally recognized expert on the health care of victims of violence and abuse. She serves on the AMA National Advisory Council on Violence and Abuse and is a member of the Board of Directors of Physicians for Reproductive Choice and Health.
I believe that the people who have financed and supported Proposition 85 are sincere, so I must ask: what do they really want? Decreased teenage abortion rates? More parental involvement with teens? Time to explore all the pros and cons of a decision regarding abortion? Whatever the real goals of Prop. 85, as Senator Clinton said in a recent phone message about this initiative: "We can do better."
If the goal of Prop. 85 is to reduce teenage abortion rates, we can do this a better way. Teen pregnancy and abortion rates are already declining in California. California was one of the first states to refuse federal funding for sex education, because educators wanted to ensure that young men and women in our state get complete information about their sexual health. If the backers of Prop. 85 really want to reduce teen pregnancy rates, they should help support legislation that requires and funds comprehensive sexuality education. We must also ensure that teens who do become sexually active - despite our concerns that their minds are not as mature as their bodies - have access to contraception. If they're not ready for sex, then by all means, they're not ready for a baby.
]]>Dr. Connie Mitchell is a nationally recognized expert on the health care of victims of violence and abuse. She serves on the AMA National Advisory Council on Violence and Abuse and is a member of the Board of Directors of Physicians for Reproductive Choice and Health.
I believe that the people who have financed and supported Proposition 85 are sincere, so I must ask: what do they really want? Decreased teenage abortion rates? More parental involvement with teens? Time to explore all the pros and cons of a decision regarding abortion? Whatever the real goals of Prop. 85, as Senator Clinton said in a recent phone message about this initiative: "We can do better."
If the goal of Prop. 85 is to reduce teenage abortion rates, we can do this a better way. Teen pregnancy and abortion rates are already declining in California. California was one of the first states to refuse federal funding for sex education, because educators wanted to ensure that young men and women in our state get complete information about their sexual health. If the backers of Prop. 85 really want to reduce teen pregnancy rates, they should help support legislation that requires and funds comprehensive sexuality education. We must also ensure that teens who do become sexually active - despite our concerns that their minds are not as mature as their bodies - have access to contraception. If they're not ready for sex, then by all means, they're not ready for a baby.
What about the goal of encouraging parental involvement and protecting teens in crisis? Parents who want their teens to turn to them in a time of crisis need to communicate their values and beliefs to their children from an early age. The majority of families do communicate, and they are involved in a daughter's decision to have an abortion. But I also know that some teens just can't talk with their parents on a variety of issues, especially anything to do with sex.
There is a better way to encourage family communication by teaching parents the skills to talk with their children about the issues that matter - not at a moment of crisis, but starting when their children are young. Prenatal care programs, early childhood education, WIC, and Family Pact are excellent programs in California that can (or could) include parent education about how to communicate on the "tough" topics.
As a doctor who studies public health, I know there is an art to crafting good health policy that benefits the targeted audience in a helpful, healthful way and that avoids imposing punitive measures or costly bureaucracy. Prop. 85 is not good health policy.
I am afraid that what Prop. 85 is really about is trying to control others. The initiative's supporters want to control women's access to and decisions about healthcare, as well as controlling the relationship between doctors and our patients. They also want to control teens' normal development, including their emerging sexuality and increasing need for independence and confidentiality as they move toward adulthood.
I think Prop. 85 is also about the lack of control that parents must face as their children grow up and become increasingly independent. As parents, we feel a lack of control everyday when we think about all the things that could hurt our children. It's natural for children to test their limits, experiment or make mistakes. Any parent will tell you that the pain of their children is worse than their own pain could ever be.
As parents, we must control the things that we can: from seatbelts and nutrition, to regular conversations about values and difficult issues, and tactics for problem solving and decision making. And as parents, we must provide guidance in anticipation of the things that we can't control: how to recognize people that don't have your best interests at heart; how to assess if a situation is safe or not; how to keep your self-respect a priority; how to be an individual that deserves respect from others; and how to accept mistakes and learn from them.
Helping kids to be smart about their bodies and helping parents to learn how to prepare their kids for peer pressures or developmental tasks is much better health policy than Prop. 85 - the former is proactive and preventive, and the benefits are greater and long lasting. Let's put our combined money, minds and energy to better use and help families with better policy than Prop. 85. VOTE NO on Prop. 85.
]]>Dr. Connie Mitchell is a nationally recognized expert on the health care of victims of violence and abuse. She serves on the AMA National Advisory Council on Violence and Abuse and is a member of the Board of Directors of Physicians for Reproductive Choice and Health.
If Prop 85 passes, teens in California will be forced to wait until their parents are notified before having an abortion. The more I think about the impact this initiative could have on young women in my state, the more I've found myself contemplating what passing this law would mean in real life. Just how long will a pregnant young woman have to wait before she can have an abortion?
]]>Dr. Connie Mitchell is a nationally recognized expert on the health care of victims of violence and abuse. She serves on the AMA National Advisory Council on Violence and Abuse and is a member of the Board of Directors of Physicians for Reproductive Choice and Health.
If Prop 85 passes, teens in California will be forced to wait until their parents are notified before having an abortion. The more I think about the impact this initiative could have on young women in my state, the more I've found myself contemplating what passing this law would mean in real life. Just how long will a pregnant young woman have to wait before she can have an abortion?
Let's imagine a typical patient-we'll call her Jane. She comes to see her doctor on a Monday to discuss an unintended pregnancy. Jane and her physician discuss her pregnancy in terms of her overall health and Jane decides to have an abortion. Before 5 pm that day, her physician sends a first class certified letter to Jane's parents informing them of her decision. Jane goes home to wait. Under Prop 85, the physician can assume the letter was delivered two days after it was mailed. So, in Jane's case, as of Wednesday, 5:00 pm, she can assume the letter as been delivered and now she begins the second waiting period. This is the 48 hour "reflection period" that would be mandated by this law. By the end of the week, Friday, 5:00 pm, Jane can have her termination procedure done.
Jane represents the best case scenario under Prop 85. Now, imagine what might happen in the worst case scenario.
Let's say that Rachel visits her physician on a Friday afternoon and decides to have an abortion. She is frightened of her parents' reaction to her pregnancy and wants to seek a judicial bypass. It's too late to go that day, so she makes her way to court on Monday. Rachel's hearing takes place on Wednesday, and the following day the judge denies her petition. She decides to appeal the decision. The appeal hearing takes place three court days later, and on Tuesday, Rachel learns her appeal was denied-she must notify her parents of her decision to have an abortion. Her doctor sends out a letter on Wednesday, and the cycle of waiting begins for another young woman. By the time Rachel's parents are notified and she waits through the mandatory delay, as many as 18 days could have passed since she first decided to have an abortion.
These scenarios aren't just idle speculation-it is important to consider how abstract laws about "48 hour reflection periods" are going to be implemented in the real world of courts and judges and bureaucracy. Any doctor can tell you that teens usually seek medical treatment when they are further along in pregnancy than pregnant older women, because they tend to be less aware of their bodies, take longer to realize that they are pregnant or must work through their shame and fear of stigma. We already know that parental notification laws cause teens to further delay seeking healthcare at a moment when timing is critical. For teens who can't speak to their parents, parental notification and judicial bypass impose yet another delay of almost 3 weeks!
The American Medical Association (AMA) and the American Academy of Pediatrics (AAP) oppose mandatory parental notification in part because these delays impede timely access to healthcare and increase the health risks to our teens. (Check out the AMA report on parental notification and AAP's policy) Forcing women to wait for healthcare is bad medicine and bad public policy.
As I contemplate the delays Prop 85 might impose on young women in California, I have to ask: how much risk are parents willing to take in order to satisfy their "need to know"? At the end of the day, isn't the safety of our teens the most important issue for parents?
]]>Dr. Connie Mitchell is a nationally recognized expert on the health care of victims of violence and abuse. She serves on the AMA National Advisory Council on Violence and Abuse and is a member of the Board of Directors of Physicians for Reproductive Choice and Health. This is another in a series of posts looking at the ballot initiative in California.
Last week, I read an opinion piece in the Sacramento Bee from a doctor who supports parental notification legislation. In his op-ed, Dr. John Gisla argued that Proposition 85 is "simple, common sense legislation." I completely disagree. Prop. 85 is neither simple nor common sense, nor is it necessary. Let's look at the facts.
]]>Dr. Connie Mitchell is a nationally recognized expert on the health care of victims of violence and abuse. She serves on the AMA National Advisory Council on Violence and Abuse and is a member of the Board of Directors of Physicians for Reproductive Choice and Health. This is another in a series of posts looking at the ballot initiative in California.
Last week, I read an opinion piece in the Sacramento Bee from a doctor who supports parental notification legislation. In his op-ed, Dr. John Gisla argued that Proposition 85 is "simple, common sense legislation." I completely disagree. Prop. 85 is neither simple nor common sense, nor is it necessary. Let's look at the facts.
It is not simple for a frightened young woman to seek a judicial bypass. A study in Pennsylvania on impact of parental consent found that only eight of 60 court districts provided complete information to teens asking about judicial bypass. It is not common sense to delay urgent health care decisions by up to two weeks for court hearings and appeals, potentially taking a safe first trimester procedure to one in the second trimester which has more health risks.
Dr. Gisla tries to make judicial bypass sound helpful by noting that "the judge would report evidence of abuse to child protective authorities." What Dr. Gisla fails to mention is that doctors in California are already required to report to law enforcement any sexual activity of a minor that they suspect is abusive, coercive, or involves concerning age disparities. There is no need for Prop. 85's additional reporting requirements and documentation bureaucracy.
Dr. Gisla also states that "there is no evidence that any girl in a state with a parental involvement law... has suffered any harm because of these laws." Really? What about Spring Adams who was cited in testimony to the House of Representatives? Her father killed her when he learned she planned to end the pregnancy that resulted from his incest. Or how about Becky Bell, an Indiana teen who died of complications from an illegal abortion she had to avoid telling her parents she was pregnant? Her parents spoke out on "60 Minutes" about their change of opinion on parental notification laws and now want them repealed nationwide.
As a doctor, I know how Prop. 85 will really affect teens in California. I've spent many hours working with teens, and I always encourage them to talk with their parents about their health concerns. I know that this holds true for all of my physician colleagues. The majority of teens already involve their parents in the decision to have an abortion, a fact that proponents of this initiative conveniently ignore. But those teens that don't want to, for whatever reason, will delay care, delay counseling, increase their own personal health risk and increase the risk of poorer pregnancy outcomes should they decide to continue the pregnancy to term.
I agree with Dr. Gisla when he wrote, "No law can mandate communication between a girl and her parents." I'm a mother of two teens, and I talk to them every day about the issues and values that are important to our family. Of course I'd want them to come to me with any important medical decision. Of course I would want them to know that I love them when they learn both in triumph and in tribulation. But above all, I want them to be safe and their wellbeing supersedes my "need to know."
I'm voting NO on 85 on November 7th because as a doctor and a mother, I don't need a law that: