As a teenager growing up in Buffalo, a city which unbeknownst to me had one of the highest teen HIV and pregnancy rates in the country, knowing how to avoid pregnancy was an issue of the utmost importance. In spite of the evidenced sexual experimentation of my peers, students at my high school were offered a poorly planned "health and nutrition" class taught by our arrogant and uninterested gym teacher. Outdated texts and grisly pictures of untreated sexually transmitted infections were used to scare us into not having sex. Few adults would talk honestly and openly about sex, sexual pleasure, and protection, and coupled with the widely used "wait until you get married" mantra, this created an environment in which sex was shrouded in mystery, shame, guilt, and confusion.
This is a fate that I am working diligently to help subsequent generations avoid.
But since starting medical school, my frustrations with the lack of widespread action to address many of the educational, social, and economic determinants of health have grown tremendously. Hearing bleak statistics about Black and Latino health is a commonplace, routinely accepted, and unquestioned part of the American medical landscape. Very seldom do our discussions then proceed to the ways in which health care providers and the medical infrastructure directly contribute to these trends. Although attempts are made to incorporate cultural competency and social analysis into our first and second year curriculum, our schedules are so full of basic yet complex molecular and physiological science that questions that cannot be answered in multiple choice format become torture. Medical school, I have quickly discovered, is not for the faint of heart; analyzing medical injustice too much or empathizing too strongly becomes problematic and overwhelming when faced with 500 pages of notes to memorize.
As a pro-choice medical student, I have sought out forums and organizations that work to provide social critique, analysis, and some form of action. However, I have found myself exceedingly frustrated with the major medical sexual and reproductive rights movement. This movement should be comfortable taking a bold stance for comprehensive reproductive health options, including sexual health education and contraception, and remaining sensitive to social factors that compromise individuals' choices and rights. But the prominence of abortion in the medical provision of reproductive health care is an issue that has provided considerable discomfort for me. This focus on abortion can obscure, for example, the necessity of providing judgment-free sexual health care and education. It can allow us to forget our obligation to move beyond cultural awareness toward cultural competence and socially-aware health care professionals. The focus on technologically-centered solutions can allow us to ignore the need for worthwhile employment and living wages for all Americans that allow families to thrive and function.
Medical school, by nature, often strips out a deeper social analysis when examining the health outcomes of different communities. The pro-choice, reproductive rights movement within medical schools should always ensure that it is sensitive to patients' socioeconomic realities and is responding to the full range of individuals' reproductive health needs. It is my belief that without a spectrum of options and the determinants to support our decisions, there is no real choice.
Although I think abortion should not be given a preeminent focus in reproductive rights and health care, the dwindling and dangerously low number of health care providers that have been trained to provide abortions is alarming and requires immediate action. Abortion training is an endeavor that interested students must seek out on their own because the overwhelming majority of medical schools do not provide any formal training. The lone reproductive rights organization at my school, Medical Students for Choice, works to increase the number of medical students trained in abortion provision. Although important, I feel that this focus is limiting because abortion is such a polarizing and emotionally-charged topic. I remain one of a handful of students of color who is actively involved and I strongly believe that there would be more widespread support and involvement if other equally important issues such as contraceptive access became the focal points of action in addition to abortion.
Ultimately, my goal as a future physician is to be able to provide a broad range of affordable and accessible contraceptive options including abortion. I am dedicating my life to empowering young women and men with honest, reliable, and scientifically-based information about their bodies and their sexualities so that they can make the best decisions for themselves and their communities free of shame, guilt, and fear.
]]>The new vaccine, Gardasil®, manufactured by Merck Pharmaceuticals, has been approved by the Food and Drug Administration (FDA) for young women, ages 9-26. Clearly Merck is putting a lot of money behind promoting this vaccine to young women. But this captivating commercial can lull young women into a false sense of security about their reproductive health.
]]>The new vaccine, Gardasil®, manufactured by Merck Pharmaceuticals, has been approved by the Food and Drug Administration (FDA) for young women, ages 9-26. Clearly Merck is putting a lot of money behind promoting this vaccine to young women. But this captivating commercial can lull young women into a false sense of security about their reproductive health.
"Want to protect yourself against cervical cancer—don't forget to get your Guardasil® shots!"
Don't get me wrong, I support any medical breakthrough than can protect women from this tragic disease. Glamorous commercials aside, all young women need to educate themselves on the causes, symptoms and prevention of HPV-related cervical cancer. Women should know that the human papillomavirus (HPV) is a sexually transmitted infection (STI); only direct skin-to-skin contact is needed for transmission. They should know that there are over 100 strains or types of HPV, thirty of which are sexually transmitted and can infect the genital areas of both men and women. They should know that, according to the Centers for Disease Control (CDC), HPV is one of the most common sexually transmitted infections (STIs) in the United States. In fact, recent estimates by the CDC suggest that one-half of sexually active women will contract genital HPV infection in their lifetimes.
It is important to note that 90% of infected women will not have any symptoms and their immune systems will clear up the virus within two years. What does that mean for the other 10%? These women could potentially develop persistent infection that can increase the risk of cervical cancer. In 2002, 3,952 women died of cervical cancer. The majority of these women did not have access to routine gynecological care. They did not get annual PAP tests that would have detected abnormal cells indicating the strain of HPV that causes cervical cancer. The striking statistics show that HPV infection can affect all women. However, it is women who are poor and without access to health care that have the most negative health outcomes, including death.
How will this vaccine help them? Current estimates suggest that the recommended full series of three shots will cost approximately $360. How will poor and young women access the vaccine? How will the millions of women without health care coverage pay for the vaccine? Under the publicly funded Medicaid program, which provides care for extremely low income populations, vaccines are an "optional" benefit. This means that states can determine if they will provide the vaccine or not. For uninsured and low income women who do not meet federal poverty standards, Merck Pharmaceuticals has announced its "patient assistance program", an initiative which claims to provide vaccines at low or no cost. However, this program will only be administered through private practices where Merck vaccines are already provided. Just how Merck Pharmaceuticals believes low income and uninsured women can gain access to expensive private clinicians remains unanswered. While I do not deny the efficacy of and the need for the vaccine, I do not want reproductive rights activists or Merck Pharmaceuticals, for that matter, to forget that alarming disparities in health care access and a glaring gap in vaccine provision still exists. The fact remains that this vaccine will remain out of reach for millions of women including those most at risk from complications.
Other important issues include the questionable period of effectiveness.
We must develop a more comprehensive approach to help protect all women from many types of STIs, unintended pregnancy, and HIV. More widespread and comprehensive education about general gynecological concerns, how to tap into free and low cost health care services, and when to seek medical treatment are necessary ingredients to ensuring that all women receive the type of reproductive health care services that can prevent cervical cancer. Winning access to routine PAP tests for all women would help save lives. Something as "simple" as promoting consistent and continuous condom use to reduce the risk of contracting HPV would be an integral part of this endeavor.
I applaud the marketing professionals who created the "One Less" campaign—it has created a buzz about the vaccine. But as a sexual and reproductive rights advocate and woman of color, I cannot let the promise of a "silver bullet" deter me from fighting for a more equitable society that embraces the idea that all women, regardless of age or economic status, deserve quality and affordable health care. As activists, let's campaign not for "One Less," but for "no more."
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