While it is a routine operation—nearly 500,000 are performed in the United States every year—the myths about vasectomies fester.
In fact, the outpatient procedure is a simple form of birth control for men, intended to be permanent, in which the health care provider closes or blocks the tubes that carry sperm. This prevents sperm from leaving the body or causing pregnancy; the body instead absorbs it. Used as birth control, vasectomies are nearly 100 percent effective.
Of course, vasectomies are not for everyone. Particularly, they must be weighed against a person or couple’s desire to have children in the future —considering such dire circumstances that may intervene in one’s life, such as death or divorce. While vasectomies can sometimes be reversed, the procedure is intended to be permanent; reversals do not always work. Doctors warn against depending upon it for any future change of heart.
Jason, a 38-year-old man from Turlock, California who had a vasectomy and asked that his last name not be used, said that vasectomies seem to be shrouded in mystery for most men.
“They don't understand that it is virtually painless,” Jason said. “It is extremely safe. Also, most men are extremely protective and shy about male organs, outside of being in a sexual situation. To think that some doctor will be cutting them open and doing stuff turns off a lot of men to the idea.”
Julius, a 49-year-old from Winston-Salem, North Carolina, noticed a similar sort of thinking.
“Men always seem to cringe when vasectomies are discussed, like it would really hurt,” Julius said. “I was in so little pain that I did have intercourse the evening of the procedure, and there was no pain involved. I had the procedure on a Friday, and was easily back to my desk job on Monday.”
Still, the mystery about vasectomies persists—and it is most prevalent outside the United States. About 43 million men around the world have undergone voluntary sterilization—compared to 180 women who have chosen sterilization, despite the fact that vasectomies are far simpler, safer, and more affordable than tubal litigation. A vasectomy costs anywhere from $350 to $1,000; female sterilization costs nearly six times as much. (Medicaid covers sterilization for both men and women.)
“Vasectomy is extremely rare in all but a few industrialized countries and China,” according to “In Their Own Right,” a 2003 report from the Guttmacher Institute on the reproductive and sexual health of men. It further reports that most men in their forties and early fifties do not want more children. Vasectomies are most prevalent in North America, parts of Western Europe, and China; it is nearly nonexistent in much of Africa, Latin America and Eastern Europe.
And yet, cued by a tight economic outlook around the world, many people are considering permanent birth control. Besides wanting to prevent against unexpected pregnancies, men in precarious jobs often want to have the procedure while they still have health insurance that covers it.
Doctors have seen a sharp increase in the number of people inquiring about the procedure, according to U.S. News and World Report. An article from last March cites Dr. Marc Goldstein of Cornell Institute for Reproductive Medicine in New York City, who estimates that he has provided about 48 percent more vasectomy consultations than he had one year ago. CNN reports that the Cleveland Clinic in Ohio has seen a 50 percent jump in the number of vasectomies that it is performing since the nadir of the recession in Fall 2008.
There is, then, an opportunity to dispel the myth and mystery around vasectomies as couples and individuals begin to ask questions they might not have asked before.
While vasectomies are becoming more common, the procedure comes in context of a complicated history. Sterilization has been abusively applied to non-voluntary individuals, particularly people of color. While women have been the primary targets of this abuse, men too have suffered coerced vasectomies.
In India in the 1970s, reports of compulsory sterilization at “vasectomy camps” began to gain notoriety around the world. Men were coerced with substantial monetary and other incentives for having a vasectomy as part of India’s attempt to lower its national birth rate. Government officials participated in many vasectomy camps, lending it a troubling authority, according to the comprehensive book The Global Family Planning Revolution. Indeed, to “persuade” men to have a vasectomy, one state withdrew public rations for families with more than three children; another state legally required sterilization after three children. In still another state, married teachers with children had to be sterilized or they would lose a month’s pay.
The traumatic legacy of this, paired with fears that the procedure inhibits virility, has caused the unpopularity of vasectomies in that nation. A Times of India report in 2004 indicates that of the 34,000 men who come to Delhi hospitals and clinics for advice about contraception, only 2,000 of them choose vasectomies.
Alongside the lingering suspicion of sterilization as a tool of abuse, vasectomies also emerge in context of the relative dearth of male birth control options. Historically, the burden of family planning has fallen on women.
Matt Johnson
wrote in AlterNet about how his
decision to have a vasectomy was in part influenced by a desire to take responsibility
for his contraception:
All the other common birth control methods (besides condoms and vasectomy) have one aspect in common: They place the onus on women. Not only does our society expect women to deal with the logistics of birth control, but these methods also have severe physiological drawbacks, from roller-coaster hormonal changes to intensifying menstruation cycles to weight and skin changes. Although these methods have come a long way in a few decades, they still burden women and their bodies. Is it any coincidence that in a male-dominated society, the medical establishment has thus far focused on birth control methods that leave the burden solely on women?
This socially conscious approach to vasectomies also takes an environmental turn. Thomjon Borges of Somerset, Massachusetts, said that he has “No regrets whatsoever” about having a vasectomy. He added that, “the chance to contribute to slowing the population growth was a plus.”Having decided that I want to take an active role in birth control, a vasectomy is fair, easy, and it confronts my privilege on this issue.
You need to navigate a courtroom obstacle course to get a judicial bypass for your abortion.
And Leah Bartelt
wants to be very clear about this: a judicial bypass is not a way to skip
around the state’s new parental notification law, but rather, it is the very
essence of the law. Bartelt says:
The media reporting on the (Illinois parental) notification law are saying that the ACLU is helping (minors) ‘exploit loopholes’ in the law,” said Bartelt, who is the reproductive rights staff counsel for the American Civil Liberties Union in Illinois. “This is incredibly frustrating because this is in the law. To say we’re exploiting loopholes is dishonest.
She added, “This isn’t bypassing the law; this is a due process right that the young women have.”
That is one bright fact that’s emerged in a tough Midwest summer. In July, the U.S. Court of Appeals dissolved the injunction on the 1995 Illinois Parental Notice of Abortion Act—meaning that a young woman cannot receive an abortion without a parent, legal guardian, grandparent, or other adult family member being notified. There is a 90-day grace period before the law takes effect, which was granted after the Illinois Medical Disciplinary Board said that it needs time to make changes to its process, which will include penalizing doctors that don’t comply with the notification law. The grace period expires in November 2009.
Illinois joins thirty-four other states that have parental involvement laws for minors seeking to terminate a pregnancy. This spring, a report from the Guttmacher Institute found that these laws seem to “have little impact on minors’ abortion rates and, by extension, birthrates and pregnancy rates,” except in Texas, where the lower number of abortions for minors seems to correlate with the increasing number of teen pregnancies. The Guttmacher report’s finding is in part because many minors travel to states without parental involvement laws in order to obtain an abortion.
The report also notes that it found “no studies that evaluated the increased costs of obtaining an abortion due to delays, travel, or bypass proceedings; the impact of minors being forced to consult their parents; or minors’ opinions about the parental involvement laws.” It urges for more research to be done.
The judicial bypass option in Illinois and elsewhere is intended to protect the rights of pregnant young women who cannot inform their parents of their pregnancy and abortion, often because of concern for their physical safety or abandonment, or because their parents are inaccessible. In such cases, a young woman seeking an abortion can bring her case to a judge, who in turn can permit the medical procedure without the required notification or consent.
The U.S. Supreme Court found in 1979 that so long as the judicial bypass option exists, mandatory parental notification or consent laws are not an infringement on the right to abortion.
Bartelt is among those who have teamed together to form The Illinois Judicial Bypass Coordination Project as a response to the state’s new restrictions. It is designed to not only protect the right of the judicial bypass, but to make it accessible to young women who might otherwise be daunted by dodging through the legal process on their own … all while trying to protect their privacy from unwelcome intrusions by their family and community.
The strategy? The Illinois Judicial Bypass Coordination Project offers a free hotline that’s available to minors between 9 am and 9 pm, six days a week, at 1-877-44-BYPASS. The hotline is staffed by trained volunteers who provide information on the regulations, timelines, who legally needs to be notified and who does not. The project also developed a comprehensive guide to help young women understand their rights related to parental notice laws, all-options counseling, and the bypass process.
“We want to get this (guide) out to abortion clinics, physicians, health care providers, school health centers, all girl-serving agencies,” Bartelt said.
Through the hotline, callers can also tap into the project’s network of pro bono lawyers. Bartelt says:
If she (the caller) knows abortion is her right choice and she wants to go to court, the volunteer will fill out her intake form (…) and we will find her a lawyer,” Bartelt said. “We’ve required lawyers to represent the young women pro bono so no one has to go to court without a lawyer.
Like the hotline volunteers, the lawyers too are trained about the parental notification law and the bypass process, including challenges that are peculiar to these situations, such as the transportation problems common among minors trying to get to their hearing while keeping the process private from their family and school.
The nation’s newest judicial bypass hotline borrows from models pioneered elsewhere, including the PATH Project facilitated by the ACLU in Florida. Created in December 2005, the PATH Project’s toll-free legal hotline (877-FLA-PATH) facilitated about 600 bypass cases in 2008, according to Bartelt. Like the new initiative in Illinois, the PATH Project guides callers to a network of pro bono attorneys, offers lawyer training.
“Our goal is to empower teens to make decisions - based on their best interests - about their own medical care,” states the PATH Project’s mission on its website.
But what may be the longest-running judicial bypass hotline comes from Jane’s Due Process, a nine-year-old organization committed to ensuring legal representation for teens in Texas.
Jane’s Due Process hosts a 24-hour toll-free hotline (1-866-www-jane), initiated after parental notification passed in Texas in 2000. (Texas has since toughened up its restrictions by passing a parental consent law.) The hotline is staffed by volunteers, including many who are law students at the University of Texas, and it helps minors find lawyers for their bypass. It also provides training to attorneys so that they are equipped to help young women navigate the court system that regularly refuses to hear these cases, despite being required to do so by law.
While Jane’s Due Process doesn’t have any marketing budget, young women find out about it via its web presence, referrals from clinics, and from an informational piece that’s available from health clinics and parenting programs.
“Girls don’t normally come looking for us until they need us,” said Tina, the hotline coordinator for Jane’s Due Process. She asked that her last name not be used.
Who are these girls who call the hotline? Last year, according to the organization’s annual report, 469 minors from around the country called Jane’s Due Process for judicial bypass assistance—up from 316 the previous year. Of these, 18 percent were mothers already supporting at least one child. This is not much of a surprise: Dallas is the U.S. city with the highest percentage (28 percent) of teen births that are from repeat pregnancies, according to a recent report from Child Trends, a nonpartisan Washington-based group that used statistics from the Centers for Disease Control and Prevention from 2006 (the most recent year the numbers are available). As a whole, Texas has the highest repeat teen birth rate of any state, for the sixth straight year, at 23%. Five of the fifteen worst ranked cities are in Texas.
In such a context, Jane’s Due Process—the only organization in Texas dedicated to work of this kind—continues to take callers. Twenty-two percent of last year’s callers reported physical or emotional abuse from their parent or guardian; many reported having been impregnated by their father. Twenty-five percent were orphans, had parents who didn’t live in the U.S. (often caught in an immigration tangle), or were otherwise inaccessible. Fully 27 percent of callers had been kicked out of their homes, or were threatened with being kicked out or disowned for being pregnant. Sixty percent of callers were 17 years old; aonly one percent was younger than fifteen. Sixty-six callers were Latino or of African or Caribbean descent; twenty-two percent were white.
In a blog on Salon headlined, “I Help Teenagers Get Secret Abortions,” an anonymous attorney that works with Jane’s Due Process describes the kind of calls she received as a hotline volunteer:
“The very first call I took … was from a 17 year old who said bluntly, ‘My mom’s in jail and my dad’s in Iraq” she was living with her older sister who was 22, but the clinics were not allowed to accept the sister’s consent because she was not the legal guardian. … I even sent a girl to Kansas once; she was a marathon runner and a track star. She lost her period every year during training season and so really did not know she was pregnant until the middle of the second trimester. (Ed note: Texas criminalizes abortions after 21 weeks) Her parents were hard-core religious, and she knew that they would turn her out on the streets no matter what happened with the pregnancy. She didn’t want to be homeless.”
Many called Jane’s Due Process asking about abortion funding and about child support issues as well as for bypass support, and many called from outside of the state. Tina directs non-Texas callers to their local Planned Parenthood clinics. Non-residents can receive bypasses in Texas, though they will then also have to have their abortion in Texas. Minors from Oklahoma and Louisiana often come in for this process. Meanwhile, minors in far west Texas often go to New Mexico for their procedure where there is no parental notification law.
Tina said that the “majority of girls (who call the hotline) are on birth control, but got pregnant anyway.” Among callers that said they were not using a condom, “72 percent reported that their partner actively refused or chose not to wear a condom,” according to the organization’s most recent annual report.
“Most minors who call are in school and are getting an excellent education,” Tina said. “There’s a misperception that it’s just low-performing minors that get pregnant.”
Bartelt, too, reported that the young women served by the Illinois Judicial Bypass Coordination Project are more varied than commonly believed.
“This (hotline) is for young women who feel trapped, who feel they can’t notify their parents--that they’d be kicked out of the house or forced to marry the father,” Bartelt said. “Others have a great relationship with their family, but—because their house just got foreclosed on, or a parent’s suffering depression—they feel they can’t inform them right now, because it would break (their parents).”
While Bartelt said that the Illinois bypass project is intended to “make it as easy as possible for (young women) to comply with the law,” and that its swift development is “a testament to the community—lawyers and non-lawyers who are aware of how hard this can be for young women, how traumatizing it is,” Bartelt emphasizes moving through the process isn’t a simple thing, no matter how much support exists.
“It’s hard. It’s not easy telling multiple strangers about your sex life and your family,” she said.
But there are thousands of young people across the country that feel that the difficulty of revealing intimate details of their lives notwithstanding, it is their best choice. And in at least a handful of states, they don’t have to go it alone.
]]>Click here for the full story.
]]>Not so for pregnant women who are incarcerated. Not only are their decisions about care restricted, but many incarcerated pregnant women are physically restricted while giving birth: during labor and delivery, they are shackled.
Consider the case of Shawanna Nelson.
When Nelson was six months pregnant, she was incarcerated in Arkansas for passing bad checks. She went into labor during her short sentence. A correctional officer shackled her legs to opposite sides of the bed that transported her to a delivery room, removing them briefly during a nurse's examination. Nelson was re-shackled immediately after giving birth to her nine-pound son.
"She suffered both mental anguish and injury to her back, intense pain because she couldn't move or adjust her position through her birth process," said Dana Sussman, legal fellow at the Center for Reproductive Rights.
Nelson later had surgery to treat symptoms resulting from the delivery of her son, according to The Arkansas Times. She sued the Arkansas Department of Correction, charging that her treatment violated the Eighth Amendment's protection against cruel and unusual punishment.
After winning her case at district court, Nelson's charges were dismissed on appeal by a judicial panel that said prison officials "couldn't have known the shackling was unconstitutional," said Sussman. Nelson was granted a rehearing before the 8th Circuit Court of Appeals, supported by the American Civil Liberties Union's National Prison Project. Her case was argued in September 2008. A decision is pending.
Perhaps most surprising about Nelson's case is that it's not uncommon. Last month, a former Washington inmate sued the state for shackling during her birthing process and high-risk pregnancy, treatment that included a leg iron and a metal chain across her stomach.
Also last month, former inmates of Cook County jail filed a federal lawsuit in Illinois challenging the facility's shackling practice. Illinois was the first state to have legislation that prohibited shackling; it remains one of four states that make shackling explicitly illegal.
"I had no idea women were treated like that anywhere," said Tina Reynolds, who was shackled during labor and the birth of her son fifteen years ago.
"Shackling is a brutal and inherently unjust practice, so blatantly draconian," said Malika Saada Saar, executive director of The Rebecca Project (and contributor to RH Reality Check).
"The problem is that policies for incarcerated men are extended to women without adapting to distinct circumstances," Saada Saar added.
The Practice of Shackling
Shackling usually happens when pregnant women are transported from one facility to another-when a woman is transferred to a new prison, for example, or when she's taken to a hospital for medical care. Reynolds herself was shackled around the waist during labor. She knows others who were subjected to a black box placed between their wrist and belly, which keeps the arms in front and facedown. Shackling also happens around ankles in transport vans and in wheelchairs, while breastfeeding, and while in neonatal nurseries, Reynolds said.
To date, 46 states have no legislation that restricts the shackling of pregnant women in prisons, jails, and detention centers, leaving the practice to the discretion of individual facilities. Illinois, California, Vermont, and New Mexico prohibit it entirely, though, as the Cook County case reveals, implementation of anti-shackling policy can be patchy.
Non-federal facilities are exempt from the U.S. Bureau of Prisons policy that, in October 2008, barred the shackling of pregnant women, "except in the most extreme circumstances." This policy is in alignment with the United Nations Convention Against Torture, which the U.S. ratified.
Shackling policies are especially pertinent given that women are the fastest growing demographic in U.S. prisons, according to the Women's Prison Association. As with the general prison population, most are serving sentences for nonviolent offenses.
Among detained immigrant women who are pregnant, the research of Meghan Rhoad of Human Rights Watch (and an RH Reality Check contributor) found that shackling frequently happens during transport and occurs less often during labor. Many pregnant women are deported before they give birth because U.S. Immigration and Customs Enforcement (ICE) tries to expedite the process for them.
"We know that some pregnant women in detention are pregnant as a result of rape that happened in their home country or while they crossed the border," Rhoad said. "That they may be forced to endure shackling as rape survivors is absurd and horrifying."
The practice of shackling discourages women from seeking needed care, Rhoad said.
"The degradation is such a disincentive," Rhoad added. "It's related to who's in immigration detention, including refugees, survivors of trauma that may have involved shackling, and people with no experience in detention centers."
The Rebecca Project's advocacy engages ICE and associations of county jails, because detained immigrant women are often placed in jails where shackling is standard practice.
"For some reason, jail policy trumps ICE policy on shackling," said Saada Saar. "This could be alleviated if ICE and others at the federal level made a clear statement."
Rhoad is optimistic that pregnant immigrant women in detention will soon have better circumstances.
"We've seen an openness in the new (Obama) administration to examine the practices in women's care," Rhoad said.
As well, The Rebecca Project's anti-shackling efforts acknowledge the frequency of shackling occurring while women are transported.
"We've done extensive work with the U.S. Marshals because they're responsible for the transportation of prisoners and are often responsible for shackling," said Saada Saar.
Anti-Shackling Movement Builds Momentum, Wins Allies
The 2008 federal policy against shackling cued renewed hope among advocates for the humane treatment of incarcerated women. Beyond lawsuits and advocacy with individual departments, legislative campaigns to restrict shackling are finding unprecedented success-after years of falling on deaf ears.
New Mexico is the most recent state to bar shackling through a bill signed by Governor Bill Richardson this spring. New York and Texas currently have bills backed by legislative support that await the word of their governors before they become law.
"For us, it's not enough to change regulations (on shackling in particular prisons)," Saada Saar said. "To do this campaign through the legislature gives us a way to respond to violations of the policy. Through state statutes, mothers' rights are better protected."
"A lot of states do have corrections policies that restrict shackling, but (the policies) aren't commonly known or understood," Sussman said. "A law allows us to go to court; it makes it hard for others to say they didn't know (that shackling is restricted).
"We have a strong case in Illinois because of the law there, for example. We need to bring cases to ensure enforcement," Sussman added. "It's a dual strategy."
It's a strategy that inspires diverse support. Broad coalitions are signing on to legislative and legal campaigns to transform the experience of giving birth in prisons, jails, and detention centers.
Among those backing the New York Anti-Shackling Bill are women's health advocates, prison rights organizations, medical and public health groups, and "even fellowships and ministries that aren't our frequent allies," Sussman said.
In Texas, there's even more strategic alignment with religious organizations and politicians in the campaign against shackling, said Sussman.
"With religious groups, what resonates is the simple inhumanity (of shackling)," said Sussman.
Rhoad said that her organization took on the anti-shackling campaign because, she said, shackling is "not just a women's right issue; it's a human rights issue."
Meanwhile, when Reynolds attended the National Organization for Women conference in Indianapolis last month, she was invited to submit a resolution for NOW to take on shackling in its national advocacy. Her resolution was adopted, which Reynolds called "a huge step, because they are a huge organization."
"That was remarkable to me to feel empowered, as a formerly incarcerated woman who had joined NOW the week before," Reynolds said.
Leaders in the anti-shackling movement credit the campaign's momentum to centering the experiences of women who were shackled. Their stories are featured at press conferences, in letters, in briefs, and other campaign vehicles. Many are collected through Women on the Rise Telling HerStory (WORTH), an association of formerly incarcerated women founded by Reynolds.
"It may be possible to resist changes (to the practice of shackling), but when you're confronted with the reality of women who've had to endure this, that's a hard position to maintain," said Rhoad.
Challengers
Despite the multifaceted support for anti-shackling legislation, the movement is not without its challengers.
The New York Department of Correctional Services (DCS) opposes the Anti-Shackling Bill that won near-unanimous legislative support and now awaits Governor Paterson's approval. The DCS contends that shackling doesn't happen in its facilities, and if it did, the department is capable of addressing the problem independently.
Serena Alfieri, associate director of policy with the Correctional Association of New York, said that DCS's point about shackling not occurring is fueled by a lack of documentation. She notes that many women don't file complaints about the practice out of fear of retaliation.
Stories about shackling most frequently come from women after they are released. There are documented stories of shackling happening as recently as February 2009, according to Alfieri.
Alfieri said opponents of anti-shackling efforts often cite security concerns about inmates using the opportunity of pregnancy and birth to escape. The New York Anti-Shackling Bill includes exceptions for terrorists and past escapees.
"It's interesting that the only argument opponents (to the Anti-Shackling Bill) really have is that prisoners will escape and therefore community safety is at stake," said Alfieri. "But (in New York) they're not even using that argument. Their saying it just doesn't happen."
It is Alfieri's theory that DCS might have taken a different strategy if "they ever vaguely even thought this bill had a chance to become a law.
"After similar bills haven't passed in recent years, (DCS) underestimated the amount of support for this," Alfieri said. The Anti-Shackling Bill's success comes after at least seven years of the issue being dropped by the legislature.
Reynolds said, "I wonder if (the DOC) knows that there is a difference between labor and birth. Because there is a difference. They might remove shackles during the actual birth, but labor-and labor pains-is experienced beyond that.
"It is painful and horrific to be shackled during labor pains," she added.
While New York's DCS goes through the pains of downsizing and union pressure, its leaders and employees are trying to ensure that not a lot of more changes are happening, Alfieri said. She believes that this contributes to DCS's opposition to the Anti-Shackling Bill-the department resists out of a desire to not cause any more upheaval than is already happening.
"Security is where they come from; the impact on the health of women and children just doesn't occur to them, it's just not on the table," Alfieri said.
Turning Point for Incarcerated Women, Reproductive Justice Advocates
Nonetheless, awareness of the impact of incarceration on women and children is rising across the nation.
Reynolds believes that growing national attention to shackling is partly attributed to empathy for the child involved in births that happen in prisons-though, she said, she hopes people recognize the connection between the child and its mother.
The momentum is further fueled by international standards against shackling pregnant women. Sussman said that the movement's approach frames the issue as violations against UN standards of torture.
"Gains on the international level are powerful for advocacy," Sussman said. "We use it in our letters, all through our campaign."
Rhoad echoed Sussman's ideas.
"Exploring this as a human rights issue is imperative," Rhoad said. "We can look at the basic standards of treatment and the strong support in the international arena for prohibiting shackling in all but the most extraordinary circumstances."
It's an idea that that offers the reproductive justice community an opportunity to evolve.
Shackling is a "very important issue for the reproductive rights community, though it hasn't quite been claimed yet," Saada Saar said. "Now is an opportunity to re-claim it and shed light on mothers' rights."
Reynolds said she agreed that shackling, as well as the impact of incarceration more broadly, remains "sorely missing in reproductive justice circles."
The Center for Reproductive Rights is "primarily an abortion access organization, but (working on the anti-shackling campaign) broadens us as a reproductive justice group," said Sussman. "The reproductive justice community believes strongly in the full spectrum of health care, including abortion access and childbirth services."
Sussman noted that reproductive justice groups that focus on particular community and regions have been among the strongest advocates in the anti-shackling campaign, recognizing, for example, how the criminal justice system impacts communities of color.
In fact, birthing rights advocates can be credited for overturning the practice of shackling in the city of Philadelphia (a policy that hasn't extended to the state of Pennsylvania).
"Doulas and midwives worked with mothers in prisons, and they're work and intervention changed that policy in Philadelphia," said Saada Saar.
It is, after all, a simple idea.
"Women should be given the opportunity to recover and heal in a treatment facility with their child," said Reynolds. "People deserve the dignity to have a child in a healthy way, free of restraints, without feeling more oppressed."
"Everybody is captivated by the story of how they were born," Reynolds added. "Why shouldn't mothers be able to tell a joyful story to their child, without worrying about leaving out details of shackles and poor care? That story they share should be pure and beautiful."
]]>But in Palin's recent television appearances, she didn't explain why school is so hard on teen parents, or why only one-third of adolescent mothers receive their diplomas.
The truth is, the nation with the highest adolescent pregnancy and birth rates in the industrialized world has not figured out how to meet the educational needs of pregnant and parenting teens. In fact, we're going in the other direction - gutting the too-rare programs that have developed to meet the unique needs of teen parents.
In June, a two-year-old residential charter school for teen mothers in Washington, D.C., will shut its doors for good. The City Council cited truancy, curricular problems, and gaps in special education services in revoking MEI Futures Academy's charter, and ignored the school's pleas to support improvement efforts. Because it is a residential school, the 50 students at MEI Futures Academy also must find a new place for themselves and their children to live.
Similar news came from Baltimore two weeks ago when the City Council voted to merge a school for pregnant and parenting teen mothers with an alternative program for boys. The reason? Cost cuts.
These moves follow New York City's decision to close its four "p-schools" in 2007 in favor of mainstreaming teen parents. A recent report from the New York Civil Liberties Union evaluating the consequences of this decision found that current services for teen parents are too few, too difficult to access, and too poorly advertised - to an embarrassing degree. The drop out rates for teen parents in New York schools are as high as 70 percent.
"We didn't think it was a problem when (the four p-schools closed) because they were really flawed - students weren't necessarily going to them voluntarily, and academically they were far from satisfactory," said Karyn Brownson, the NYCLU's teen health initiative director. "But when they closed, the Department of Education wasn't really prepared to replace and expand the services (to pregnant and parenting teens) in traditional schools."
Insufficient data about parenting students makes it difficult to evaluate existing programs. Beyond the abysmal retention of parenting students, Brownson said that the NYCLU has heard anecdotally about pregnant students being pressured out of school and into GED programs because it was "obvious they're not college-bound" and "they're supposedly a bad influence on other students."
Yet unequal access to education for parenting students is a violation of Title IX, said Lara Kaufmann, senior counsel with the National Women's Law Center. "A student's pregnancy, childbirth or termination of pregnancy are all specifically included in Title IX's protections against sex discrimination in publicly funded schools," Kaufmann explained.
But while Title IX is famous for its role in ensuring access to sports opportunities for girls, its protections for equal educational opportunities for parenting students are less well known and frequently violated.
"People are generally supportive of gender equity in sports, but many don't have the same sympathy for pregnant students," Kaufmann said. "There's still a stigma that pregnancy is their fault, that they should be punished, and there's a great myth that if you support pregnant students, it will make other teenagers want to get pregnant too."
This myth "defies common sense--young people aren't getting pregnant because their school gives them access to childcare," said Kaufmann. "And stigmatizing or discriminating against pregnant and parenting students is not only illegal, but it is bad educational policy because it increases the risk that those students will drop out."
While Title IX affirms the right of parenting students to equal education, very few legal cases have been filed to enforce these rights.
This is because, Kaufmann said, "it's really hard to bring a lawsuit, particularly if you are a teenager. Lawsuits are not only financially draining--and many of the girls we're talking about are from low-income families--but they also can be emotionally draining. .... And it's also important to note that many pregnant and parenting teens are not even aware of their legal rights."
Given that, Kaufmann added, it is "especially critical that the U.S. Department of Education's Office for Civil Rights aggressively and proactively enforce the law in this area."
Not much of that is happening right now, however. There is nothing typical when it comes to the services that schools offer to pregnant and parenting teens because the vast majority of them do not offer any support at all, said Kaufmann.
But there are some schools that prove the possibilities - and the worth - of ensuring educational opportunities for young parents.
If we can escape the trap of taking anything we can get, it's worth looking at what, exactly, is working best in contemporary p-schools so that we can develop a strong foundation for advocacy in New York, in Baltimore, in Washington, D.C., and far beyond.
Catherine Ferguson Academy
Detroit's Catherine Ferguson Academy, a public high school for pregnant and parenting teen girls, is perhaps the shining star of a school system that's under emergency financial management. Despite the school district's struggles, CFA has won national recognition over its 20 years of operation for its educational innovations and high graduation rate.
CFA, which hosts up to 400 students (and 200 children) at a time, boasts a 90% graduation rate and a 100% college acceptance rate for students who earn diplomas. These numbers are superior even to many traditional high schools in Detroit.
"At first, I was a little bit skeptical--an all-girls school?--it's not going to work ... " said Evelyn Locke, a CFA senior, on a recent episode of Al Jazeera's Fault Lines. "But it's really not that bad." Locke became pregnant in ninth grade; this year she's graduating and going on to study neo-natal nursing.
Ebony S. Griffin-Williams is a 1996 graduate of CFA who credits the school for helping her get a high school degree and become an IT analyst. "Before attending CFA my future was bleak. I was one of many of Detroit ... lost children... and I'm almost positive if I did not attend CFA I would have become a Teenage-Mother-High School-Drop-Out," wrote Griffin-Williams in an online review of the school. "CFA became my family. One of the most outstanding teaching methods taught to me by the loving staff of CFA was how important it is to have self-pride."
So what's helping these teen mothers to defy the statistics?
First of all, CFA takes a standard expectation for p-schools - free on-site day care - a step further and offers free early education classes, including kindergarten, to young children. CFA‘s childcare staff extends its hours for students taking extra evening classes at a nearby community college.
The school offers a flexible schedule based on quarters over nine months and four-day weeks; this leaves teen mothers sufficient time to keep appointments and make up absences. Among the credits counted for graduation are parenting education classes, which allow the mothers to participate in activities alongside their children.
An on-site nursing and midwifery clinic offering pre- and post-natal support minimizes absences. It also facilitates access to Women, Infants, & Children (WiC), the federal program that offers supplemental foods to low-income parents.
Speaking of food: CFA has an on-site organic farm featuring vegetables, animals, and a student-built barn. The farm is maintained by students, volunteers, and science teacher Paul Weertz. The project began as Weertz's creative response to pregnant students who couldn't use chemicals in science class; rather than dissecting animals, the students created a living laboratory outdoors on vacant land that surrounded the school. Today the farm serves as an opportunity for science and construction education, healthful food served regularly in school, and activities for mothers and their children to share.
One of the greatest challenges p-schools face is a lack of public awareness about their existence; when school districts and the city don't consistently promote educational opportunities for pregnant and parenting teens, students who need those services are often unaware they exist, making drop-outs at traditional schools more likely. CFA takes the lack of promotion into its own hands. This spring, the school hosted a citywide baby shower that drew nearly 100 young mothers and their children to the party. There, Principal Asenath Andrews encouraged them to enroll at Catherine Ferguson and make the possibilities of pursuing their education - even higher education - a reality.
And she did it with the spirit of celebration and possibility-not punishment. Andrews once told me about how other p-school programs she'd encountered were housed in the same building as programs for youth who were expelled or in trouble with the law. "You'd think they'd done something illegal," Andrews said.
Finally, and perhaps most uniquely, is that Catherine Ferguson Academy is able to offer students essential consistency. Rather than being a temporary "bridge" program that expects teen parents to move on to a traditional high school, students are eligible for enrollment at CFA from the time they become pregnant until the time they graduate. New students register in August of each year on a first-come, first-serve basis; there is typically no waiting list.
Lund Family Center
The Lund Family Center in Vermont is not a school, but a 501c3 nonprofit and a multifaceted residential program for teen mothers. While its student body is primarily drawn from Vermont, Lund occasionally enrolls students from neighboring states. Lund's services come at no cost to students; its programming is funded by a diverse base, including the Vermont Department of Education, the Department of Human Services, private donations, and school districts that direct students to Lund.
Among its many services is an education program tailored to the needs of each student. Lund's New Horizons Educational Program is approved by the Vermont's Department of Education and serves about 35 students a year on a rolling admission (some in-residence, others as day students) through an ongoing school year. On staff in the classroom are three certified teachers, a part-time tutor and a classroom assistant that work directly with students.
Of the teens that Lund serves, about 50% had previously dropped out of school and some are coming out of the corrections system. They are between the ages of 12 and 27, thereby serving a wider range of students than CFA is able to, though not nearly as many of them.
"(We) ... can provide transitional services to assist a student mother in returning to her high school, or continue to educate the mom until she obtains a diploma from her high school," Kris Hoffman, the educational services coordinator, explained. "We develop educational plans one at a time for each student, and have achieved great success in this model, although it is very labor intensive for our teachers."
Hoffman is clear that p-schools can't skimp on resources if they expect to be successful. From access to diaper-changing, breastfeeding and milk-pumping, as well as frequent breaks and appropriate maternity leave, Hoffman emphasized that adolescent student mothers need flexibility. "Our teachers can teach three kinds of math in the same room while holding a baby," said Kitty Bartlett, Lund's communications and development coordinator.
While CFA offers students long-term stability in their hometown, easing the obstacles towards graduation, Lund's residential model gives students a safe space away from their native cities. "The common misconception is that the early pregnancy is the only issue facing the student mother," Hoffman said. But according to Bartlett, most student mothers at Lund have a "history of poverty, a pretty significant history of trauma, and often mental illness, medical, and substance abuse issues." Hoffman contends that the gender-specific environment helps the center to work with multiple issues simultaneously.
The program offers "maternity leave, post-secondary educational counseling, referral to substance abuse and mental health treatment, free lunch and snacks, and peer support," said Hoffman.
Lund makes a commitment to the children of its residents and day-school students, offering childcare even after the teen parents transition out of the program if it makes sense for the child. It also helps teens find quality preschools for their children in the town they return to.
Finally, Lund tries hard to help young mothers be teenagers as much as possible and appropriate. "We've seen that not supporting this developmental phase [of being a teenager] is detrimental to the vulnerable families with which we work," Hoffman said. "Adolescence is a time of growth and change, and simply treating teen moms as adults does not help them to move forward toward independence."
Some in the teen pregnancy prevention movement are suspicious of programs for adolescent parents, believing that they serve as an enticement to pregnancy. Hoffman argues that it's important to overlay such programs with traditional environments, particularly for very young mothers.
"I've noticed that really young mothers, aged 12-15, become almost institutionalized when they remain in teen parent education programs for their entire secondary school careers, and might continue to feel entitled to public assistance and community involvement if they do not move on to a different academic setting," she said. "However, if educational support is provided in a teen parent ed model for these youngest mothers during the year that they are working on pregnancy and childbirth, return to traditional high school can be very productive."
White River Online
For adolescent student parents without access to a p-school, online education is an option to continue schooling. As an alternative program of the White River School District in Buckley, Washington, White River Online serves just over 60 full-time students between the ages of 12-21 with a standard high school curriculum. It issues diplomas and hosts an annual graduation ceremony.
While it is not a program specifically targeting pregnant and parenting teens, its flexible schedule and accessibility make it a viable choice for them. Danielle McIntosh, a White River Online teacher, estimates that at least 10% of White River's students are pregnant or parenting, though the only way the school knows if its students are parents is if they tell them about it.
If they do so, White River Online is willing to work with them and their unique circumstances. "I would say we unofficially cut them some slack that we probably wouldn't extent to other students," said McIntosh. "For example, a parenting student recently had a sick baby. Just a cold, but nap times were disrupted so work times were also disrupted. We just extended her deadlines to meet the situation."
Ensuring Fair and Equal Access to Education
School districts and cities that ignore the needs of pregnant and parenting students would do well to observe that proven, workable p-school models exist. Therefore, doing anything less than making these models standard and accessible is at best ill-informed and at worst cruel. Not to mention bordering on illegal - teenagers have a legal right to public education, no matter what their parenting status is.
That translates into a requirement for schools to adapt their policies for unexcused absences, make-up work, doctor's notes, home instruction, transportation, individualized graduation plans, counseling, and class scheduling for the needs of pregnant and parenting teens - without steering them into inferior or academically lax programs.
"I don't think there's one right answer (for how to support the educational success of parenting students), in terms of whether programs in traditional schools or separate settings are better," said NWLC's Lara Kaufmann, while emphasizing that significantly more research and data is needed in this area.
"We know of promising examples following both models," Kaufmann added. "What this tells us is that there is more than one way to provide the necessary supports, and that's encouraging. As long as they comply with the law, schools can be creative about how they help their parenting students. The important thing is the substance, not the form."
Whether it's a four-year high school, a multifaceted residential facility or an accredited online program, the goal should be to provide several viable options for students to meet their various needs. While some students need the stability and peer-experience of attending a comprehensive school like Catherine Ferguson Academy in their hometowns, others might not find this to be the best option.
When it comes to p-schools, Hoffman has a request: "If you have these programs in your areas, please help teens and tweens to see them!"
The thing is, there should be no "if" -- these programs need to be in all of our areas. To paraphrase the NYCLU, not just one but two lives depend on it.
]]>No doubt this is reason to cheer. But rejecting abstinence-only funding is only one part of the movement to educate and empower young people; we also need to pro-actively normalize comprehensive, medically-accurate sexuality education in American schools.
"Turning back ab-only funds won't stop ab-only teaching," said Bill Smith, SEICUS vice president for public policy. "At least, it's not a guarantee."
Despite the momentum against ab-only funds, Smith said that there hasn't been a proportional uptick in comprehensive sex ed programs - and there won't be one if there continues to be no federal investment. Ab-only curricula took their hold in U.S. classrooms precisely because of the strong funding structure for those programs, Smith said. It's not merely the absence of ab-only funding that will translate into comprehensive sex ed programs; rather, comprehensive programs need a strong funding structure of their own in order to be normalized. After all, up-to-date and accurate textbooks and teacher training don't come free even to the most well-intentioned school districts.
While the Cleveland Metropolitan School District and Pittsburgh Public Schools are among the relatively few districts that are finding ways to support more comprehensive sex education, the question is: how much more comprehensive are they? Are the sex ed programs in these pioneering districts truly medically accurate and age appropriate? Or do alternative funding and curriculum models carry their own set of restrictions and limitations?
The Cleveland Model
The Cleveland Metropolitan School District launched a K-12 comprehensive program in 2006, a program that Smith points to as "probably further advanced and more progressive" than any other in the country.
It started in 2006 when Cuyahoga County leaders decided to re-allocate TANF and City of Cleveland dollars away from an abstinence-only curriculum and towards a comprehensive one. County commissioners made the shift as a response to community leaders and parents who showed them the evidence of the link between the district's ab-only program and the county's troubling health statistics.
"That was a leadership position the county took," said Laureen Tews Harbert, program director of Cleveland's AIDS Funding Collaborative.
The more comprehensive curriculum was funded almost entirely by TANF dollars in its first year, according to Marsha Egbert, senior program officer of The George Gund Foundation, a Cleveland-based private nonprofit that provides operating support for the new curriculum. But CMSD couldn't rely on TANF: it only had three years of support that incrementally diminished each year. The three-year window for TANF funding expired in December 2008.
"The short term time frame on the TANF support accelerated our effort to bring support for the program fully in house," said Egbert.
CMSD evolved its model into one of diversified funding, including private support, and internal capacity.
"At first, we delegated the sex ed teaching to outside, specially-designated professionals responsible for this course alone," Harbert said. "That was costly. The model evolved, with a concerted effort, to train health and PE teachers to be responsible for the bulk of the curriculum."
Training existing staff makes CMSD's sex education a more sustainable model, Harbert added.
Further, CMSD replaced lower TANF funds with support from The George Gund Foundation and The Cleveland Foundation. CMSD also partners with Harbert's AIDS Funding Collaborative for the annual evaluation of the new curriculum. The City of Cleveland continues to provide funding as well through community development block grants.
"Having a variety of funders who have a stake in the program speaks well for its future success and the community buy-in," Harbert said. "At the same time, building our internal capacity for comprehensive sex ed makes us more sustainable because we're less dependent on outside support."
So what does Cleveland's program look like? Is it really comprehensive?
Formally called the Responsible Sexual Behavior Education Initiative, the Cleveland model appears to be one of the only K-12 integrated sex education programs (that is, a program that builds on each previous year), if it's not the only. According to Egbert, the curriculum includes information about contraceptive use, sexually transmitted diseases, and a "tremendous amount on emotional and social development, including refusal skills and negotiation skills. That to me is a critical part. Students can get the facts, but it's important to teach ways for them to make the facts work in their lives."
As well, the Cleveland program partners with the nonprofit Scenarios USA, which uses scriptwriting and film to "capture the voices of reproductive health and sex topics," Egbert said. Fifteen million people each year see the short films from Scenarios USA at film festivals, in schools, and on television.
How, though, is the Responsible Sexual Behavior Initiative working?
Philliber Research Associates, the external evaluator of the effectiveness of Cleveland's sexuality education, indicates in its 2007-2008 report that the program reached 26,326 K-12 students. Health and PE teachers newly trained for sexuality education were rated highly for their abilities to teach about dating, gender roles, HIV/STDs prevention, reproductive anatomy, decision-making skills, puberty, and pregnancy prevention.
However, those same teachers were rated as "least able to teach" about community resources, sexual abuse prevention, and sexual orientations. They also were described as "less comfortable discussing" condom use, sexual intercourse, and sexual orientation with students.
The evaluation also indicates that after participating in the new Cleveland curriculum, significantly more students disagreed with the statements, "I would have sex with someone even if I really don't want to" and "If a partner refused to wear a condom, I would probably give in and have sex with him/her."
Compared to students who hadn't yet participated in the programs, those who participated in Cleveland's sexuality education showed significantly improved knowledge and skill sets across all grade levels.
"There's still a lot of work to be done" in making the program fully comprehensive, said Egbert. "Particularly in making the different parts of the program mesh. But we're committed to improving the program each year."
Such a commitment is wonderful news for Cleveland, and especially the city's young people. But what stands out is the rarity of its curriculum. Even with its gaps, there is no other one like it in the nation-even in those school districts that are re-evaluating ab-only funding and programs. Egbert noted that when Cleveland first set out to develop its K-12 comprehensive curriculum, it found no models existed-not in school-based forms that were rigorously evaluated, at least.
Piecing Together Models
Harbert noted that Cleveland's K-12 curriculum for age-appropriate sex education was so uncommon, administrators had to piece together a new model based on four different model curriculums to create one that was evidence-based and age-appropriate.
"It does seem like we've received a number of inquiries from other school districts about our model," Harbert said. "Our research shows we're pretty unique in offering this - there's just not a lot of models out there."
Curriculum for any school district is accepted or rejected by the school district. According to Howell, districts often hire someone who is a curriculum specialist to implement guidelines. Without strong models of sex ed syllabi, it's easy for even well-intentioned districts to have holes in their curriculum.
Pittsburgh's "Abstinence-Plus"
Meanwhile, Pittsburgh Public Schools, for example, is a district that announced just weeks ago that it'll move away from its model of abstinence-only-until-marriage and begin teaching "about contraception, dating and alternative lifestyles ... (as well as) sexual orientation, marriage and life commitments, sexual dysfunction, sexual abuse and gender roles," reports the Pittsburgh Tribune-Review. Citing the city's high teen pregnancy rate, the new policy passed the school board with an 8-1 vote.
"The change in Pittsburgh happened because parents called into question what their kids are being taught," Smith said. "Which shows you how attention paid to the issue is how change happens."
It's a positive step towards better educating students. However, this more comprehensive model is uneven. Described as "abstinence-plus," the program will still emphasize abstinence as the best choice for students and will not distribute or demonstrate contraceptives or contraception methods.
Developing a Comprehensive Model
Champions of comprehensive sex ed are working to remedy such a patchy application of comprehensive sexuality education by developing model curricula. Advocates for Youth, for example, offers sample lesson plans on its website that indicate what kids should be learning at each age. It includes plans for teaching about body image, addressing discrimination, reducing sexual risk, and discerning your own values about your sexuality.
More expansively, SEICUS, Advocates for Youth and Answer pulled together national leaders in December 2008 for a Future of Sex Education project. The task? "To develop national guidelines for what we mean with comprehensive sex education," Smith said.
These national guidelines - which will include information about contraception, sexual orientations, gender identity, sexual abuse, and, yes, even choosing abstinence - continue to be developed in collaboration.
In the meantime, advocacy organizations are focused on convincing governments to redirect abstinence-only funds to support the kind of comprehensive sex ed programs that are proven to reduce teen pregnancy and STDs.
States can take the initiative.
California is recognized for never having accepted ab-only funds from the federal government, but rather prioritizing comprehensive education with a law that, according to Marcela Howell, vice-president of Advocates for Youth, says that districts don't have to teach sex ed, but if they do, they must include particular information - like STD treatment and prevention and the effectiveness of all FDA-approved contraceptives - that is part of the comprehensive vision.
States can plug the hole in federal investment by taking responsibility for its own dollars. "The State of Florida squandered its own $17 million spent on ab-only since 2002," Smith said. "If they can invest $17 million in ab-only programs, they can spend it on a more comprehensive program."For the most wide-ranging impact, national organizations turn their attention to top.
"What we're like to see is, under a new Congress, under a new White House with a president who's made a commitment to comprehensive sex education, we have a very simple ask: Stop funding the bad programs and start funding the good ones," Howell said.
]]>According to the "adoption consensus," whatever one thinks about the justness of abortion or the reasonability of expecting a person to raise a child she's not prepared for, we can at least agree to support policy that will better facilitate adoption. This is utterly uncontroversial. Right?
There are plenty of inconsistencies in adoption law from state to state, and plenty of ways policymakers could streamline adoption for women who wish to relinquish and parents who wish to adopt. But is any of the legislation that purports to facilitate adoption really going to do that? And even if it did, would it have any affect at all on the abortion rate?
One of the most heated debates in adoption policy is over original birth certificates, says Adam Pertman, executive director of the Evan B. Donaldson Adoption Institute and author of Adoption Nation. Adults who have been adopted often cannot obtain their original birth certificates because most states keep them sealed. "This is a policy issue that treats adopted people differently from their non-adopted counterparts," Pertman says.
In some cases, this policy has been reversed. Since 1996, Alabama, Delaware, Maine, New Hampshire, Oregon and Tennessee changed their policies so that adults who were adopted can have access to their birth certificates. Those records in Alaska and Kansas have always been open for adults.
Unsealing records is crucial for adopted adults and, more generally, for a compassionate and sensible adoption system. It doesn't, however, appear to have any particular affect on whether a woman chooses to place her child for adoption, according to Pertman.
"These are wildly different states, geographically and politically," Pertman says. "And their adoption rate is similar to any other state, which indicates that sealing or not sealing records doesn't really influence a mother (who is considering relinquishing her child)."
According to Pertman, the principal argument for keeping birth certificates inaccessible to adopted people is that unsealing records will violate anonymity promised to the birthmother. But, Pertman says, the historical record reveals that's not the reason records were sealed in the first place; rather, they were sealed to protect the adoptive family from the birthmother, who feared she would show up at their doorstep. A report issued last year by the Donaldson Institute found that states that opened records to adopted persons saw no evidence of negative consequences predicted by opponents of the change, such as stalking by adopted persons or damage to birthmothers.
Abortion is implicated in this policy issue by those who fear that unsealing birth records will cause more women to choose an abortion who'd otherwise only place their child for adoption if they were promised total anonymity. Pertman says this argument's popularity is "diminishing greatly" because it has "no basis in reality." "From a statistical and evidence-based point-of-view, it simply is not true," he says. "But viscerally, it has influence."
That influence begs conflict among those who agree to better facilitate adoption when some are primarily motivated by a desire to reduce abortions; improved adoption policy that doesn't seem to lead to reduced abortions may not be championed by them. However, that doesn't mean that improved adoption policy isn't essential for its own sake.
"It is important to improve the adoption systems and policies because there are problems with them and they're not serving any of the parties involved with it as well as they should be," says Jessica Arons, director of the Women's Health and Rights program at the Center for American Progress. But Arons questions the usefulness of focusing on adoption policy as a "compromise" on disagreements about abortion rights, because improving adoption will have little to no impact on the U.S. abortion rate.
"There are very few women who would've given up a child for adoption, but then say to themselves that, ‘oh, well, the system's messed up, so I'll go ahead and have an abortion,'" Arons says. "That's just not the conversation going on in people's heads."
Democrats for Life say they have a bill that would reduce the abortion rate by 95% in 10 years (reproductive health advocates strongly dispute that characterization of the bill). Part of the way they plan to do that is by increasing the adoption tax credit, and making it permanent. But would making adoption more affordable for families - undoubtedly a social good in its own right - really affect the decision-making of American women facing unintended pregnancy?
Regardless of what effect it might have on the abortion rate, much of the work of making adoptions affordable currently falls to charities. Becky Fawcett, a New York City mother who adopted her son, Jake, co-founded Helpusadopt.org, which offers grants of up to $15,000 to people interested in adopting, with her husband.
"Adoption is not for the faint-hearted, and when you put a $40,000 price tag on it, that's frightening for people," Fawcett says. "It's not that people who can't afford adoption were irresponsible with their money. But who has $40,000-$50,000 in their savings to just write out for an adoption?"
In its first year, Fawcett reports that Helpusadopt.org has met with an extraordinary response. "This need isn't going away - adoptions can be expensive and difficult and emotionally hard for everyone involved. If we can make it a little easier or people, then I'm proud of that," Fawcett said.
On RH Reality Check, Cory Richards of the Guttmacher Institute lauds strategies that, like Helpusadopt.org, make adoption a real and viable option for people. But he calls out adoption advocacy that's born of the desire to see the abortion rate drop.
"Politicians from both parties frequently promote tax credits and other incentives to ease the way for adoptive parents to demonstrate that they want to ‘do something' about abortion," Richards writes. "Facilitating adoptions, especially of hard-to-place children, deserves our strong support. But it does nothing to affect the abortion rate. ... we know that very few women actually place their infants for adoption."
Richards noted that in the US, fewer than 14,000 infants were given up for adoption in 2003--a less-than-1% rate that's been consistent for almost two decades, halting there after a decline that the US Department of Health and Human Services attributes to the rising social acceptance of single parenthood.
For those in the 1% who want to place their child for adoption, for the thousands of children in foster care who need permanent homes, and for potential parents who want to adopt a child, we might hope for common sense public policies on adoption.
Yes,
let's increase the adoption tax credit, and make it permanent. Let's
ensure birth certificates are accessible for adopted persons, as they
are for any other adult. Let's ensure that minors who want to give
their child for adoption can do so safely and compassionately, without
undue legal interference. But we shouldn't pretend it'll have an effect
on the abortion rate. Policy that's designed to make adoption a "compromise," implying that adoption will replace abortion or parenting for those with unintended pregnancies, is more than unhelpful: it's dangerously simplistic.
The story comes out of New Jersey. There, the Cherry Hill Women's Center provides reproductive and gynecological health services, including abortions. It was established in the 1970s, and is a member of the National Abortion Federation and the National Coalition of Abortion Providers.
As part of the center's support services, it developed a partnership with a local hotel, the Clarion Hotel & Conference Center, to offer out-of-town abortion patients a discounted rate on a room.
On October 20, LifeNews, an online anti-abortion publication, published an article that reported on this partnership, drawing on information it received from New Jersey Right to Life.
"The Clarion Hotel in Cherry Hill offers a reduced rate of $59 for a room originally priced at $109 to women staying there from out of town to get an abortion. Women need only show a receipt from the abortion business saying an overnight stay is necessary," according to the article.
It also indicated that the Quality Inn in Maple Shade, NJ, had a similar arrangement with the same women's center.
LifeNews described how anti-abortion groups were beginning to boycott the hotels, and urged its readership to further protest a policy that it said was aiding those who want to skirt parental notification laws in other states (New Jersey itself doesn't have a parental notification law; attempts to ban interstate travel of teens seeking abortion have never become law). LifeNews offered contact information for the hotels so readers could address them directly, and, presumably, articulate their distress at the policy.
Within just a couple days, other anti-abortion groups picked up the story, and passed it to their own email lists and membership bases. The Family Research Council, in an email blast, wrote alarmingly of how the hotels are "profiting" off of abortion by offering the discounted rates. It is unclear why the FRC believes that renting rooms at less than cost to certain guests brings the hotel a profit.
"Of course, the hotels may honestly believe that theirs is a compassionate offer. But even with the best of intentions, a discount like this only makes it more affordable for young girls to cross state lines for an abortion," claimed Tony Perkins's Washington Update, an FRC e-newsletter. "Ironically, both the Quality Inn and the Clarion are part of an umbrella corporation called Choice Hotels International. Join us in urging the Choice chain to choose life."
Their members did just that. By October 24, Family Research Council passed on another e-newsletter to its base, this time celebrating that the email/telephone protest against the policy that spread across the larger anti-abortion community worked. The Clarion Hotel had decided to cease offering discounted rates to patients of the Cherry Hill Women's Center.
From the FRC e-newsletter:
If you don't believe that a few minutes of your time can change the world, we can prove it. On Wednesday, the Update highlighted a story from New Jersey where two hotels were offering room discounts to women who could prove they had abortions at a nearby clinic. We encouraged you to contact the franchise and voice your values. Today, I'm happy to report that after just two days, your overwhelming response through phone calls and emails has resulted in an immediate change of policy.
Yesterday, we received a letter from the corporate office of Choice Hotels. It reads, "'A copy of the Washington Update (dated October 22, 2008)... recently crossed my desk. It referenced two hotels within the Choice Hotels franchise system. The email message highlighted your organization's concerns regarding these hotels, and I wanted to take this opportunity to respond to you directly as this issue has been resolved. The Clarion Hotel & Conference Center, upon reflection, has ended the practice of offering special rates to patients of the Cherry Hill Women's Center... we do try to be sensitive to issues and questions raised when it is within our power to do so and we are happy to provide you with this positive update...' Sincerely, Anne Madison, Vice President, Corporate Communications, Choice Hotels International, Inc."
We applaud Choice Hotels for moving so swiftly to correct this problem and congratulate all of you who took the time to be pro-active--and perhaps save a few lives in the process.
"The Clarion Hotel paid attention to their local market and decided to make this change," said David Peikin, senior director of corporate communications at Choice Hotels International, when asked by RH Reality Check for further comment. He also said that CHI heard from The Quality Inn that the hotel never did offer discounted rates to patients of the women's center.
Peiken added that the policy to offer or not offer a discount to women's center patients did not originate with CHI.
"We heard from the concerned public and of course we passed on what we heard to (the hotels)," Peiken said. "We offer some national rates and discounts, but the local ones are negotiated locally."
This was as much information as Peiken was willing to offer; he did not answer further questions. Meanwhile, repeated phone calls to the Clarion Hotel itself resulted in silence.
"We're not allowed to talk about that," said one Clarion Hotel desk clerk who did not give her name.
"I'm not going to answer questions on this," said another Clarion Hotel employee who did not give his name or title, but who was described by the desk clerk as a "manager."
"We don't do business with them (the Cherry Hill Women's Center)," the Clarion manager said before hanging up abruptly.
And so, it's as if it never was. The support once offered by the Clarion Hotel for patients of its local women's center is swiftly rescinded and silenced.
While the Family Research Council, LifeNews, and other organizations that oppose abortion rights celebrate the change, and the Clarion Hotel avoids it, there is no indication that they will offer any concrete alternative to the patients of the Cherry Hill Women's Center who don't have a place to stay.
It's an especially pertinent point. In New Jersey, 19% of counties and two metropolitan areas had no abortion provider, according to the Guttmacher Institute. In the Northeast census region that includes New Jersey, 11% of women traveled at least 50 miles to have an abortion, and a further three percent traveled more than 100 miles. It's apparent that lack of immediate local access to abortion requires many girls and women to travel to receive one.
New Jersey actually has a lower rate of counties without an abortion provider than most states, including those that border it. Eight percent of New York counties lack an abortion provider, according to the National Women's Law Center. Pennsylvania has a rate of 39%. Delaware: 17%. And the Family Research Council is right about one thing: with restrictive policies preventing teenagers and women from obtaining abortions in states across the nation, those with higher concentrations of abortion providers and with less invasive laws are indeed more likely to attract women seeking abortion.
What's more, the Cherry Hill Women's Center offers second trimester abortions and non-surgical abortions. Both of these procedures require two-day appointments; patients, then, must have a local place to stay overnight to enable proper medical monitoring and care. For women who don't live in town, or who are struggling already to pay for the abortion and their travel, discounted lodging at local hotels is a crucial part of making the procedure accessible.
Travel and Lodging A Critical Component of Abortion Access
Stephanie Poggi is the executive director of the National Network of Abortion Funds, a coalition of 106 funds that provide people seeking an abortion with referral, financial, and emotional support. Many of these funds offer traveling and lodging support, Poggi said, and with the current economic downturn, that need is "skyrocketing."
"We're getting tons of calls from women who are economically disadvantaged, and there's more of those than ever," Poggi said. "They don't have the gas money to drive four hours [to the nearest clinic]. They're laid off, or are under the prospect of being laid off."
The financial burden on women seeking abortion is exacerbated by the fact that only 15 states cover abortion with Medicaid, and even in those states that do, many people aren't able to take advantage of it. Immigrants, for example, have to wait five years before they quality for Medicaid.
As well, Poggi added, lodging is an added burden in states that have a 24-hour required waiting period for abortions.
Half of the counties in Southern and Midwestern states don't have an abortion provider, meaning that travel is an especially big barrier for people seeking abortions. But, Poggi, pointed out, that doesn't mean "safe states" with fewer restrictive laws and a higher number of providers -- states like New Jersey -- are free of burdens.
"Even states that are ‘better' have problems with full access," Poggi said. "No state is free of barriers."
She pointed out that "women with money will be able to travel anywhere to have an abortion if they need it. It's the lower-income women who are being hurt by all this."
What's the good news then?
To fill the void and make abortions an accessible and healthy experience for those who need them, thousands of individuals and organizations are stepping up. NNAF groups are run almost entirely by volunteers. Haven, for example, is a New York abortion fund that hosts women in the homes of volunteers when they must travel for an abortion. Other funds house women in hotels, or offer vouchers to ease the cost. Sometimes there are discounted meals at local restaurants available, ensuring that patients will be able to eat.
In a time of greater need and greater scarcity, in a time when anti-abortion activists are angling to cut off support services abruptly while offering no safe alternative, it's the compassionate action of the abortion funds and those individuals who simply lend their time and care that's making all the difference.
"The National Network of Abortion Funds last year raised over $3 million and helped over 20,000 women," Poggi said. "Volunteers are doing this work out of their own compassion, and the word is spreading."
Gaylon Alcaraz, executive director of the Chicago Abortion Fund, said she too sees the need for practical support increasing. Alcaraz said that the fund is receiving calls from "all across Chicagoland and Illinois, parts of Missouri and Indiana where there are no abortion providers, people who are coming to Chicago for an abortion and definitely need practical support for transportation and lodging."
Poggi acknowledged that a sustainable solution requires more systemic change. She's pleased that allies of the NNAF are increasingly organizing around the economic barriers to safe and accessible abortion. Until that happens, however, the funds are needed to offer the safe alternatives that are unavailable elsewhere.
]]>Perhaps it's not a surprise that neither Sen. Barack Obama or Sen. John McCain dwells too long on what, in particular, will lose its funding in the next year. But truth may be revealed by omission; that is, an issue that the candidates don't discuss much on stump speeches, interviews and debates probably isn't their unqualified spending priority.
That should make those who use and support publicly funded birth control - the "Janes" if you will - nervous.
There are 17 million American women who need subsidized contraception services and supplies, including 4.9 million teenagers and 11.8 million adult women whose income is below or just above the federal poverty line, according to the Guttmacher Institute.
Lauren is one of them. The 20-year-old California native receives a reduced rate for birth control through the Family Planning, Access, Care and Treatment (FamilyPACT) program in her state. FamilyPACT provides no-cost reproductive health services and contraception to men, women and teens of child-bearing age and ability.
Lauren says that lots of her friends and family members "have been just stoked to walk out of Planned Parenthood or their local health department with whatever birth control they want, entirely free. It's almost a foreign concept." But she also said that the positive affects of FamilyPACT reach far beyond any one individual's pocketbook and peace of mind.
"(FamilyPACT has) been shown to reduce rates of unintended pregnancy all around," she says. "It also allows people in California the rare opportunity to have one aspect of their health completely taken care of, free of charge. "
FamilyPACT is sponsored by the California government. Together, federal and state governments spent $1.26 billion on family planning services and supplies in FY 2001. The largest source of those funds: Medicaid, with $770 million spent on reimbursing providers of medical care for the contraceptive services they supply to those who need help to afford care.
Shalyn is an 18-year-old from California who receives a reduced contraception rate through Medicaid.
"I think the impact is enormous and allows people to take their health in their own hands," says Shalyn.
She too sees these services as under threat, however--a threat that she says is caused by the myopia of those who aren't directly affected by the program.
"I get the feeling a lot of the people who do not receive direct benefits from these programs think they are unnecessary and think it wouldn't be a bad idea to cut them drastically in times were money is tight," she says.
Without the support of Medicaid for reproductive health services, "some people would probably resort to methods that are free, but are not as effective, like pulling out," Shalyn says. "Unwanted pregnancies and welfare rates would go up. The people who get help from these programs can't pay for their own medical care, [so] how are they supposed to pay for prenatal care and an unplanned child?"
While Medicaid has a broader health focus, Title X of the Public Health Service Act stands out as the only federal program exclusively dedicated to family planning. Fifteen percent of all public funding for family planning comes from Title X, which, in FY 2001, translated into $189 million. According to the Guttmacher Institute, Title X serves men and women "who do not meet the narrow eligibility requirements for coverage under Medicaid, and sets standards for the provision of family planning services, ensuring that care is voluntary, confidential and available on a sliding-fee scale or free for the poorest of the poor." Funding for Title X is 61% lower today than it was in 1980, when inflation is taken into account, says Guttmacher. An annual Congressional appropriation provides the core funding for Title X programs. This appropriation, plus Medicaid reimbursements and other Federal sources account for more than half of Title X-funded clinics' operational funds.
Each dollar invested in Title X family planning saves $3.80 in Medicaid costs for pregnancy-related health care, including care of newborns.
Without publicly funded birth control and services, Lauren sees a daunting future for her community, where "young and older adults alike wouldn't be able to afford contraception ... I think pregnancy and STI rates would shoot through the roof. ... There's no way in hell many women will be willing to be prodded in stirrups when they'll have to pay an arm and a leg for it, then be sent home with a $420+ prescription for a year of birth control pills."
The threat of that future, though, is uncomfortably present. The last time Lauren went to her clinic, the place was plastered in fliers that urged visitors to write letters to their lawmakers, asking them not to cut funding for FamilyPACT. Not to mention the more coded threat encroaching on their work: Lauren has noticed the tendency for crisis pregnancy centers to set up shop quite close to the clinics that offer a full--and honest--scope of reproductive health services.
In Washington, RH Reality Check's Heather Corinna participates in a program similar to FamilyPACT. It's called Take Charge, and Corinna says that its reproductive services are particularly crucial for minors who are uninsured, who aren't eligible for their parents' insurance coverage, or who don't feel comfortable or safe using their parents' insurance for sexual health care.
"The most effective methods of contraception are costly, particularly those like the implant or an IUD, which means one payment of several hundred dollars upfront," Corinna says.
But through Take Charge, Corinna says, those people who are in the greatest need of contraception, but have the lowest income level, can still obtain reliable forms of birth control.
Instead of being embraced as a standard for all of Washington's citizens, this publicly funded program is also subject to political and economic pressures. Corinna reports that "it really depends largely on the governor's race this year: if Dino Rossi wins, this (program) absolutely will be under threat. If Christine Gregoire does, I think it will easily be protected. "
But the security of the program depends on the White House as well.
"[President] Bush not only cut family planning funding over the last eight years; he consistently put individuals in positions of power with that program who patently and openly did not support the very service it is supposed to provide, [people] who were anti-contraception," Corinna says. "I have no reason to believe that a McCain/Palin win would not continue the same sorts of practices."
Should reproductive health services be knifed under the leadership elected on November 4, Corinna says she'll find herself without the yearly check-ups she needs. What's more, she believes that "there certainly are many, many women here who would be far more hurt by the loss of this program than myself."
The numbers are astonishing: even with uncertain footing, publicly supported contraceptive services "help women prevent 1.3 million unplanned pregnancies, which would result in 632,300 abortions, 533,800 unintended births and 165,000 miscarriages," according to the Guttmacher Institute. If these programs didn't exist, there would be a 40% increase in the number of abortions in the U.S.
It must be acknowledged that publicly funded contraception and sexual health services are hardly without their troubles, outside of uncertain funding and political support. Some people who abuse the mission of these programs to serve under-resourced individuals.
Lauren says that at her clinic in California, the program runs on an "honor system" that patients can abuse.
"When you go, they ask you to self-report your income and family size," Lauren says. "Even if they see that you're covered under an insurance policy, it's common knowledge that all you have to say is ‘My parents/partner can't know I'm here,' and you get services for free."
Lauren says that her mother encouraged her to take advantage of the system.
"My mom knew I was sexually active at one point and told me to go to the health department because she didn't want to pay for my pills," she says.
Internal problems notwithstanding, the solution is hardly to decimate the state and federal funding that family planning programs depend on to serve low-income people. The nagging numbers reveal that while services need to improve, they certainly must exist, if not be expanded into a standard of healthcare and human rights.
Research proves, for example, that without publicly funded contraceptive services, an additional 386,000 teens would become pregnant, increasing the rate of teenage births by 25% and teenage abortions by 58%.
It's a direction that nobody wants our society to go in. But, when family planning barely musters as a talking point for most candidates for elected office, when the dollars are draining from every sector in the nation, how could we possibly change the direction we may be headed?
Shalyn and Lauren both have ideas for how we need to take action.
"People need to stop thinking of health care as a commodity," Shalyn says. "People need to realize that birth control and yearly paps and reproductive care are really important parts of life--personally, socially, economically, holistically."
"We must elect a president who is pro-choice and pro-contraception, and continue fighting in our own states to either keep or improve the coverage we have, or demand a family planning program where one doesn't exist," Lauren says. "We first and foremost must support Planned Parenthood and independent, feminist, women-run health clinics that fight and flounder every day to make sure money is no factor for women having a voice in their reproductive health in states with an anti-choice political atmosphere."
]]>And it's all fascinating to follow, if at times disorienting. (Is it seriously former senator Rick Santorum who is lecturing us that "women should have the right to do, in the workplace, what men do"?).
But something's missing.
The fact is, responsible people who are ready to become parents face a brutal economic environment and longstanding workplace, insurance and government policies that don't support those who want to build families. The lack of family leave or flexible schedule policies, unequal pay for equal work, and inadequate health insurance coverage discourages those who want to have kids, even when they are emotionally ready for them.
And god forbid there be any surprises.
Jennifer Flaten was living in Buffalo, Minnesota, seven years ago when she and her husband decided to have their first child. They planned costs to be sure that they could support a baby, but it all had to be reworked when the couple found out at the 16-week ultrasound that they were having twins.
"The costs of two little infants were crazy," Flaten said. "I couldn't afford to quit work, but yet 90 percent of my salary went to child care. We dragged on never quite making ends meet."
Then came a third child two years later.
"Three kids totally drained every remaining amount of money we had," Flaten said.
The family adapted: Flaten's husband received a promotion, they moved to a cheaper house, and Flaten found part-time work as an administrative assistant that allows her to choose the days that she works based on what's needed in her home.
The strain, though, isn't forgotten.
"People should not have to choose between family life--that is, not having one--or work," Flaten said.
It's an unfortunate cycle: if someone wants to have a family, they need money to support it. That typically means that they have to work. Workplace policies and government labor policies are hostile to parental responsibilities. Parents, then, are forced to choose between not being able to afford the kids they have, or not having the kids they want.
The results are predictable. In an August 2008 analysis of newly released census data, the National Women's Law Center revealed that child poverty rose to 18% last year, from 17.4% in 2006. That translates into an increase of half a million impoverished children in one year's time.
Nikki Maxwell is a 39-year-old mother of three living in North Hills, California. As an employee of California State University, she was well-supported when she chose to have children. A human resources staff member took the time to explain the family and health policies. As a union member, she received six weeks paid leave. Her co-workers were responsive to the flexible hours she needed at the office.
By the time her third child was born, though, Maxwell worked in a new department.
"[In the new department], nobody had children and you were expected to work weekends and evenings," Maxwell said. "I just couldn't do that anymore. It was time to leave."
She left CSU to work as a consultant from home. But her timing, she said, couldn't have been worse.
"The economy has tanked and we've gone from being fairly stable and secure as parents to feeling stressed and unsure," she said. "I like my flexible lifestyle, but I don't like not have health insurance for my kids."
She added that while she and her husband planned their first child, the other two were unexpected. "I'm not sure I ever would have had more children on purpose," Maxwell said. "It's a big, responsible and scary job to be a parent these days.
"I would adopt (another child) if I felt I could afford it. I can't afford more children at this point."
Amy Minton, a writer in San Antonio, shares this frustration.
"Frankly, I'd love to adopt, but the financial and medical bills for that are way out of our league. Why isn't it more affordable to adopt so that middle-class people can do it? That frustrates me," she said.
Becoming a parent in and of itself wasn't without economic strain for Minton.
"When I had my baby in 2000, I worked for myself and had a crappy individual policy. I paid cash to midwives for the birth, and we negotiated with the hospital on a payment plan. I went back to work the day after I gave birth," she said.
"Now, in 2008, with an employer that offers family leave and a crappy health care plan I can't afford--so I still have the same individual insurance plan--I wouldn't think of having a baby," Minton said. "I've seen too many new moms here at work get caught in the system they thought would take care of them. Then they get passed over for promotions because their focus is on family."
Health Insurance Out of Reach
Kevin Sullivan is an insurance broker from San Francisco who acknowledges a broader health insurance strategy that designs policies to discourage potential parents.
"Even an inquiry for adopting a child, or, too many visits to the OB-GYN, could result in a decline for health insurance," Sullivan said. "In most states, the (insurance) application (asks) ... ‘Are you currently pregnant?' ‘Are you seeking to adopt a child?' ‘What was the reason for your last OB-GYN visit?'" Sullivan said. "Any indication regarding an upcoming child and you risk decline."
Many individual insurance plans consider pregnancy is a pre-existing condition, whether or not you were aware of it, and it becomes grounds for the denial or exclusion of coverage. Under a federal law known as HIPAA, group plans that offer maternity coverage are barred from considering pregnancy a pre-existing condition. Medicaid does accept women who are already pregnant.
The NWLC reports that 17.1 million women were uninsured in 2007.
Why the rejections? Sullivan said that an insurance company looking to minimize risk doesn't consider it a stable investment to issue a policy to a potential parent.
"They could be adopting an HIV-positive, paraplegic with cancer from a third world country," Sullivan said. "Insurance companies don't like unknowns."
Both Sen. Barack Obama and Sen. John McCain are campaigning on health care reform. Obama proposes "quality, affordable and portable coverage" available for purchase by all individuals and businesses. It would have guaranteed eligibility--no one would be turned away for illnesses or pre-existing conditions--and would include mandatory coverage for children.
Sen.
McCain proposes to reform the tax code to offer more health insurance choices,
beyond employer-based coverage. Families and individuals would receive a
refundable tax credit to help offset the cost of insurance. McCain says that he
will work with governors to find solutions so that those with pre-existing
conditions will find easy access to care.
With economic and workplace policies at odds with family planning, it's enough to make many new parents feel relieved if they got by.
Meanwhile, Paul Schillio, also of St. Joseph, is a new father who's grateful that he and his wife got paid leave after their child's birth.
"I'm very thankful that both (my wife and I) are in jobs that allow [financial questions] to not be an issue for us," Schillio said. "Our decision came from our desire to have a family -- our life was missing something bigger and it almost felt like we were in a rut, living only for ourselves. But that is our emotional reason."
We might hope that all potential parents are able to plan and grow their families based on the "emotional reason," rather than workplace, insurance and government policies that, for all the "family values" rhetoric their sponsors might espouse, usually don't offer what families need.
What Works?
Sen. Barack Obama brought equal pay for equal work into the campaign, both in his nomination acceptance speech at the Democratic convention and in an ad he's airing in Virginia. (Sen. John McCain, meanwhile, is opposed to equal pay for equal work, on the grounds that it's too burdensome for businesses and that women need more education and training to succeed in the workplace.) NWLC reports that women earned 78 percent of what men earned for comparable work in 2008.
It seems so intuitive that it's laughable, but certainly an equal pay policy that from the top level will better provide parents with the financial resources they need to raise children well.
The Family Medical Leave Act provides for up to twelve weeks of unpaid maternity and paternity leave, but for many new parents, three months without a paycheck is untenable. Some workplaces fill the gap by keeping employees on the payroll when they're caring for their newborn. Liam Sullivan of Cambridge, Massachusetts, found that the strong union for Harvard University employees helped him get health and family benefits that might've been inaccessible otherwise.
"Even as the father I was able to take off 20 days to spend with my son when he was a newborn," Sullivan said. "The union also has a scholarship fund to help pay for child care so my wife and I can work full-time. I don't know where I would be without these benefits."
Other parents struggle of the eligibility requirements of the FMLA. You must have been employed at least 12 months or worked more than 1,250 hours with an employer of at least 50 employees in order to qualify for leave. When Ben Rimes, of St. Joseph, Michigan, and his wife were surprised by their first daughter, neither parent had worked at his or her job long enough to qualify for FMLA maternity or paternity leave.
The next set of elected officials has the opportunity to take the lead on updating the FMLA so that it not only suits the real-life circumstances of parents, but it finally parallels the national policies of other nations.
Talk of expanding FMLA has reached Washington. Obama states that he will expand the act by covering businesses with 25 or more employees and, beyond its current limited uses, allowing workers to take leave for elder care, participation in their children's academic activities, home care, and for survivors of domestic violence and sexual assault. Obama also proposes a strategy that will urge states to adopt paid-leave policies.
McCain voted for the FMLA in 1993, while also voting to suspend the act unless the federal government certified that compliance wouldn't increase business expenses, or alternatively provided financial assistance to businesses to cover related costs. McCain also co-sponsored the Family Friendly Workplace Act, which aimed to allow employers to provide flexible work schedules for employees to balance their work and family lives. It permitted employees to take compensatory time-off (as opposed to paid overtime) and to work more than 40 hours in one week and proportionally less in another week.
Welcoming Workplaces
Workplaces can make significant strides in how welcoming they are to new parents. Flexible work schedules are particularly craved by parents. When technology enables us to accomplish so much outside of the office walls, it's surprising that more employers aren't readily adapting.
Says Jennifer Flaten: "Allowing flexible hours and reasonable time off is important. My husband worked for a large retail company and you couldn't call in sick without losing a point. Lose too many points and you are fired. You had to come in if your kid was sick to explain to your manager -- or lie -- and hope to be sent home in order not to lose a point."
Nikki Maxwell wants to see clear policies about pumping and breastfeeding in the workplace, as well as breaks for employees to either be with their newborn or to pump.
"I hear a lot of stories through Le Leche League about moms who are pumping in a bathroom stall at work and crying and feeling horrible," Maxwell said.
"That type of environment makes unhappy employees." she said. "[I want to see] companies that really do appreciate families instead of just paying lip service to them." This election year, our candidates should pay families more than lip service, too.
]]>The draw? It's the Saddleback Civil Forum on Leadership and Compassion. Rick Warren, founding pastor of Orange County's 22,000-member Saddleback Church, and author of the bestseller The Purpose-Driven Life, will moderate back-to-back conversations with Obama and McCain, focusing on "faith and the common good."
Warren pitches the Saddleback forum in press materials as an opportunity to transcend "partisan ‘gotcha' questions" in conversations that will focus on poverty, HIV/AIDS, climate change and human rights. Obama and McCain will each spend an hour with the pastor. All questions will be Warren's own.
But the Saddleback Forum isn't significant merely for its high-profile participants. It's also a manifestation of how the traditional evangelical platform--so conflated with Republicanism that the term "religious right" was coined--is broadening beyond opposition to legal abortion and same-sex marriage.
It's been four years since gay marriage bans were put on the November ballots of eleven states, and four years since President Bush won 78% of the white evangelical vote--a larger percentage of that electorate than any candidate had ever received. Many evangelical voters have long considered abortion and same-sex marriage to be deal-breaker issues for any candidate running for office-even offices that couldn't possibly make any influential policies on them, such as mayors and school boards.
"Local politicians are still in their positions to represent their constituents, so I still find it important that their decisions stem from similar core values as those I hold," says Kari Gates, a 30-year-old evangelical voter from Fort Worth, TX, explaining why she has prioritized, without exception, any political candidates' position on abortion and same-sex marriage.
Gates follows the traditional pattern of an evangelical who identifies as a Republican (she offers the caveat: "if a candidate were running who met my criteria and was of another party, I would vote in their favor").
But the broad picture is getting complicated these days, as evangelicals expand their political platform beyond the issues that have thus far defined them. The Saddleback Civil Forum's emphasis on poverty, HIV/AIDS, climate change and human rights is indicative of this. In the promotional materials of one of the evangelical movement's most prominent public spaces, facilitated by one of its most popular pastors, there's not even a mention of the sexuality politics.
To be sure, Warren and other evangelical leaders maintain staunch and public opposition to legal abortion and gay marriage, even as traditionally progressive concerns become part of their advocacy, including anti-war activism and the Evangelical Call to Action on Climate Change, signed by more than 130 influential evangelicals. In the lead-up to the 2004 election, Warren issued a letter to 136,000 pastors and laity that said "pro-life and pro-family issues" should determine their vote.
While some leaders of the older generation, such as Jim Wallis of Sojourners, have spent decades calling for a broadened evangelicism, its young evangelicals who fuel it today.
In an election season that recognizes young voters to be as powerful a force as they ever have been, white evangelical voters aged 18-29 are significantly less likely to identify as Republicans, according to a Pew Research Center study from last fall.
Since 2005, there has been a 15% drop in GOP affiliation among these young voters, bringing the total down to 40%. Meanwhile, there was only a 5% drop in the older evangelical generation's Republican Party connection.
The Pew study directly ties the falling numbers to dissatisfaction with President Bush's administration, despite the strong evangelical support Bush received in his 2004 re-election campaign.
But this political shift among young evangelical voters doesn't necessarily translate into support for Democrats or progressive politics. The Pew study contends that while this group has grown less Republican, it's still conservative. On some matters, its actually grown more conservative, as measured by, among other things, the 70% that support "making it more difficult for a woman to get an abortion," compared to the 55% of older evangelicals.
The research study doesn't speculate about why there's such a gap among evangelicals on abortion in particular, but it does suggest that "strong allegiance to conservatism and conservative positions (of young white evangelicals) ... may be the product of dissatisfaction with this particular administration rather than the result of an underlying shift in this group's political values and policy views."
At the same time, the study reveals that young evangelicals are less bothered by gay marriage and are more concerned about health care and the environment.
"Republicans now have only a two-to-one advantage over Democrats among younger white evangelicals, compared with a nearly four-to-one edge in 2005," the study declares. As a recent New Yorker article points out, 43% of white evangelicals in Ohio voted in the Democratic primary, along with one-third of Missouri and Tennessee evangelicals.
It's too simplistic to say that young evangelical voters are growing more progressive or more conservative, but it is fair to say that they are generally more contextual: sexuality politics don't carry trump-card weight all the time when it comes alongside concerns about the environment, poverty, and war.
Trish Stack, a 28-year-old evangelical from Boise, says that she seems conservative compared with the wider world, but among many evangelicals, she's considered liberal. She takes that as her cue to call herself a moderate.
"I do not agree with drilling for oil in an arctic reserve and I do believe that we should be less dependent on oil. These are issues that are not traditionally Republican," Stack says. "On the other hand, I have tended to lean pro-life and pro-traditional marriage, as well as free-trade."
Mark Longhurst is a 28-year-old graduate of Harvard Divinity School who grew up in an evangelical family. He ceased to identify with the movement because he differs with its stance on gender and sexuality.
"It became clear to me that I couldn't be pro-gay and a male feminist, and be taken seriously as an evangelical," Longhurst says. "And vice versa."
At the same time, Longhurst says that he "loves evangelicals." He remains a Christian, working with the Boston Faith and Justice Network, which is an ecumenical community working to, as Longhurst put it, "bring evangelicals and mainliners together." This fall, the BFJN is launching a fair-trade campaign, which Longhurst said is something that "brings people together, people who wouldn't be in the same room together."
Longhurst says he is excited to see the changes in evangelical political patterns. "It's tapped into the younger generation more, but not exclusively," he says.
Jessica Davis is a 24-year-old evangelical from Pigeon Forge, TN. While she is a conservative, she saw the broad political differences among her evangelical peers while she was a student at Duke University.
"Most of my evangelical Christian friends at Duke were liberals," Davis says. "This astounded me."
Davis adds, "I think some Christians tend to focus on personal integrity and morality, and end up on the right, while some focus on the societal justice and equality side (of Christianity), and end up on the left."
No longer representing the single-issue voting bloc that Republicans have been able to consider as their base for years, the Saddleback Civil Forum is doing well to focus today's questioning on several issues that are of the utmost importance for the next presidential administration. Poverty, in particular, has been a buried conversation for too long in this campaign.
But as both Obama and McCain reach out to evangelical voters at Saddleback, Rick Warren has an opportunity to make plain the tectonic shifts in their movement and, for a change, without the triggers of sexuality politics.
It would be all too easy for Warren to use his questions to imply a stock list of priorities among all evangelical voters, and let the candidates pander. But if Warren were able to convey the differences among evangelicals--even those who differ with the prominent pastor on his own anti-gay rights agenda, for example, as part of the forum's emphasis on "human rights"--maybe we'll actually get some honest conversation (dare I say, "straight talk?").
Related Post
Jessica Mattingly, a doula from Blue Springs, MO, notes that midwifery-assisted home birth can foster the understanding that "birth is a normal, celebrated, empowering experience for a woman and her family." And, she adds, "This is not done at the sacrifice of safety for mother and baby, but at the enhancement of it. Midwives and mothers can be and are able to identify the rare cases when medical intervention is needed and can seek collaboration and assistance."
The Fight for Licensure
While dozens of professions drew their numbers together in widespread licensing systems in the last century, midwifery was not among them. While the reasons for this are unclear, it may coincide with the rise of obstetrics in the early 1900s, which seemed to be a competitor to midwifery. The profession pitched more sanitary and better-educated doctors, and that message resonated. By 1955, one percent of American births took place at home, the same rate that stands today.
The lack of licensure is a sticking point for a profession that seeks to provide high-quality, evidence-based care to women, because midwifery skeptics point to it as evidence that the practice is unsafe and unpredictable. Critics claim that its apparent lack of regulation indicates that midwifery unnecessarily endangers both the mother and the baby.
Today you need a license in the U.S. to practice psychotherapy and cosmetology, to drive trucks and to be a mortician -- but not to minister to laboring women in homes or in birthing centers. Or at least, not quite: Twenty-one states, including Wisconsin, Montana, and, very recently, Missouri and South Dakota, accept the certified professional midwife credential (CPM) for direct-entry midwife licensure. ("Direct-entry" means that standard midwifery training is recognized as sufficient to practice; the CPM isn't expected to secure an additional medical degree.) CPMs are backed by the North American Registry of Midwives "to provide out-of-hospital maternity care for healthy women experiencing normal pregnancies," according to Steff Hedenkamp of the advocacy organization, The Big Push for Midwives.
CPMs complete training that lasts three to five years and requires hours in birth observations, classrooms, and clinics. CPMs also pass a national board exam that includes a clinical assessment, out-of-hospital training, and continuing education and re-certification every three years. The CPM is recognized by the American Public Health Association as a basis for licensure.
But while CPMs are certified in their profession and practice across the country, they're not necessarily licensed. Licensure is up to boards that are set up on a state-to-state basis, and it is here that things get complicated. Certification by itself doesn't offer legal protection or permission to practice. When a state makes licensing available, it protects the midwife from criminal charges for practicing, even at the highest CPM standards. It's also likely to increase its number of active midwives, and those midwives will be more accessible to citizens via public awareness and, potentially, insurance reimbursement.
In more than half the U.S. states, midwives are vulnerable to prosecution for practicing medicine without a license. In 2006, an Indiana midwife who had overseen 1,500 births was prosecuted for just that when a baby she delivered didn't live. The law that could have put her in prison for eight years, and ultimately put her on probation, still stands. Midwives who practice in the District of Columbia, Georgia, Hawaii, and many other states face the same threat. Yet they're unable to receive licenses in states that don't recognize midwifery as a viable profession and, rather, see OB/GYN care in hospitals to be the appropriate route for laboring women.
Traditional Medical Organizations Oppose Home Birth
At its 2008 annual meeting in Chicago last month, the American Medical Association passed a resolution opposing home birth. While it didn't directly oppose direct-entry midwifery, it cited the "twenty-one states (that) currently license midwives to attend home births, all using the certified professional midwife (CPM) credential (CPM or "lay" midwives)..." as cause for its challenge to home birth.
The AMA resolution quoted the American College of Obstetricians and Gynecologists in saying that "the safest setting for labor, delivery, and the immediate post-partum period is in the hospital, or a birthing center within a hospital complex."
For its part, ACOG reiterated its opposition to home births last February:
ACOG acknowledges a woman's right to make informed decisions regarding her delivery and to have a choice in choosing her health care provider, but ACOG does not support programs that advocate for, or individuals who provide, home births... Childbirth decisions should not be dictated or influenced by what's fashionable, trendy, or the latest cause célèbre. Despite the rosy picture painted by home birth advocates, a seemingly normal labor and delivery can quickly become life-threatening for both the mother and baby.
While the AMA and ACOG are more accepting of midwives who work within hospitals, or in birthing centers that partner with OB/GYNs, the opposition to home births and "individuals who provide home births" equates into an invalidation of midwifery as a whole. Midwifery is fine, the implication goes, so long as it is safely within the realm of traditional hospitals, OB/GYNs, and nurses.
Physician disapproval of direct-entry midwifery assisting in home births resonates with the experience of California mother Alexis Aherns.
"When I told my final doctor later in the pregnancy that I was planning a home birth, he told me he didn't recommend that, and added that he had seen plenty of women who made that choice show up with dead babies," Aherns said. "It was such a ridiculous statement that it actually didn't even faze me." Despite her doctor's predictions, Aherns delivered a healthy child at home with the assistance of a midwife.
ACOG's position on home birth is one that Mattingly challenges as "terribly hypocritical and a violation of the ACOG Code of Professional Ethics which has as an ethical foundation 'the respect for the right of individual patients to make their own choices about their health care."
The original AMA resolution last month cited the popularity of Ricki Lake's recent documentary, "The Business of Being Born," which features her own birth experience as a catalyst for its resolution. Due to popular outcry, however, the AMA soon voted to delete references to Lake and the documentary from its resolution, while maintaining its opposition to home birth.
Though AMA, ACOG, and others skeptical of midwifery and home birth declare their concern for the well-being of the laboring mother and her baby, numerous reports indicate that home births are safe and minimally intrusive.
The British Medical Journal surveyed the 5,400 North American women who had home births with a CPM in 2005. No mothers died and five babies died, or .09 %. In context, the U.S., where nearly all births take place in hospitals, ranks 37th in world infant mortality; there are 6.37 deaths for every 1,000 live births, a rate behind South Korea and Cuba, according to the CIA World Factbook. The U.S.'s infant morality rate is second-worst in the developed world.
The journal survey also found that twelve percent of the home births were transferred to a hospital. Caesarean sections among these women were one-fifth the level of comparable groups who had hospital births.
A recent article in Florida's St. Petersburg Times quotes the AMA's citation of a study that compares a 1.7 per 1,000 death rate for babies born in hospitals and a 3.5 per 1,000 rate for those born at home. Home birth advocates charge that women should have the ability to choose what risks they want to face; many see the high rate of c-sections, drugs and labor inductions in hospitals as equally risky. They also point to other research that describes home births as being at least as safe as hospital births.
Doctors and Midwives React to the AMA
Dr. Henry Dorn of High Point, NC, is one OB/GYN -- and former AMA member -- who questions the recent obstacles to widespread licensure for midwives. Dorn operates a gynecology practice that offers midwifery services.
"I feel that (the AMA's) statement may stem from a combination of ignorance or avoidance of the facts regarding out-of-hospital birth by skilled attendants, and perhaps a desire to protect the business interests of the physician community,"
Dorn said. "This is not to say that AMA members do not care for their patients' best interests, but only that given the current medical climate, it would not be surprising to see those outside pressures affect [their] conclusions."
Dorn expects the resolution to "discourage another generation of doctors from considering alternatives to highly medicalized birth, as most feel that any statements by the AMA should be viewed as gospel."
Mattingly wonders if the root issue is that many doctors fear what they don't know. "Very few doctors have seen a birth without any medical intervention," she said. That means, "Most have never ever seen a normal birth."
Despite its discouraging tone, Coral Slavin of Well-Rounded Maternity Center in Menomonee Falls, WI, thinks the resolution will have an unexpected effect.
"Ironically, I think that the AMA stand against out-of-hospital birth has only driven more people to view Ricki Lake's documentary and spurred more questions. I don't see how lawmakers morally could ban out-of-hospital birth without proof of the alleged dangers," Slavin said.
Dr. Elizabeth Allemann, a physician from Harrisburg, MO (she is not an AMA member) found another reason to be positive: "Honestly, there's a little bit of a relief in having them actually make the statement. Now we no longer have to try to convince legislators that organized medicine is opposed to home birth and midwives, and can't be a good-faith partner in designing legislation."
If Midwives and Physicians Could Collaborate
The stance the AMA and ACOG have taken against non-hospital births, alongside the de facto stance taken by states that don't allow for midwife licensure, diminishes a culture of collaboration among doctors, midwives, and expecting women. While the two professional organizations detach themselves from CPMS, many midwives and home birth advocates recognize the important role OB/GYNs play in their vision for a renewed culture of birth.
Comparatively, home births are actively encouraged by U.K. governments, and in Edinburgh in particular. Nicola Goodall is an Edinburgh doula who reports that OB/GYNs and midwifes are partnering in an effort to respond to more babies being born than there are hospital units to accommodate them; Goodall said the collective goal is to increase home births by 800%. It's an ambition that also translates into making midwifery an appealing and accessible profession.
"Midwives are registered here and they work alongside doctors and hospitals," Goodall said. "All women giving birth in the UK get midwifery care, but they may get it alongside doctors if they have a special need (such as) a medical problem like diabetes."
Stateside, many are working to diminish the unfriendly competition that dates back to the development of obstetrics one hundred years ago.
Steff Hedenkamp of The Big Push outlines the way the AMA and midwives could collaborate:
We welcome the AMA joining the Big Push as we work to bring together a national effort that is creating meaningful consumer protections and a new model for the U.S. maternity care system -- one into which midwives are fully integrated. We welcome the AMA applying its vast resources to helping create a maternity care system that supports people from all walks of life from all over the U.S.
For their part, midwives often see the benefits of working with allopathic providers.
"We know that this partnership is needed to create that optimal environment for all mothers and babies," said Dr. Allemann.
For more information:]]>
The Business of Being Born - Official Film Website
The Big Push for Midwives
American Medical Association Resolution 205: Home Deliveries
"A bundle of debate over giving birth at home" -St. Petersburg Times
Or, of course, you can hear directly from women who've had the operation. It's not difficult to find them; 600,000 women have a hysterectomy each year, says Dr. Jay Goldberg, director of the Jefferson Fibroid Center at Jefferson Medical College in Philadelphia.
Put another way: one in three women has a hysterectomy before her 60th birthday. Yet treatment for life-threatening illnesses -- uterine and ovarian cancers -- accounts for only 10% of the procedures.
The other reasons? About 40% of hysterectomies are performed due to fibroids. Endometriosis, a condition in which uterine tissue grows outside of the uterus, accounts for others. Heavy bleeding, a uterine prolapse (when the organ slips out of place), a caution against cancer, birth control, and, for trans men, sexual reassignment surgery, are all among other reasons for hysterectomies.
Many who have the operation are making their best choice, and have never felt better. But what are the real implications of removing a major reproductive organ from a woman's body -- even when she doesn't desire giving birth to children? "In truth," Natalie Angier writes in Woman: An Intimate Geography, "
...we know remarkably little about the purpose of the various opiates, chemicals, hormones, and hormone precursors that the uterus secretes with such vigor. We don't know how important the output is to our overall health and well-being beyond considerations of reproduction, nor do we know whether the various secretory skills continue past menopause. ... We should be humbled by the fact that scientists discovered the very dramatic concentrations of anandamide in the uterus as recently as the late 1990s. And that humbleness should in turn enhance our vigilance against removing the uterus in all but the most extreme circumstances.
Women who have a hysterectomy require six to twelve weeks of recovery time -- a testament to the procedure's gravity. And HERS chronicles a long list of adverse consequences of the operation that call its widespread acceptance into question. Among the after-affects reported by women who had hysterectomies include personality change (79%); profound fatigue (76.9%); diminished or absent sexual desire (75.2%); short term memory loss (66.9%); insomnia (60.5%); and pain in joints and bones (59.9%). In Woman, Angier reports that hysterectomies -- even surgeries that preserve the ovaries -- cause a woman a "heightened risk of high blood pressure and heart disease ... possibly because the extraction of the uterus eliminates one source of prostaglandins that help protect blood vessels."
Deborah McConnell, a nurse at Boston's Brigham and Women's Hospital, said that hysterectomies that remove the ovaries cause immediate menopause, because of sudden disappearance of hormones ovaries release. "The sudden drop [in hormones] can have affects on bone health, heart health and mood effects as well," McConnell says.
So it's surprising that for illnesses that can be treated less invasively, alternative treatments aren't offered more often. And there are many possible treatments for fibroids, endometriosis, and pain: mymoectomies or lapatotomies to remove fibroids; uterine fibroid embolization (blocks blood supply to fibroids for shrinkage); endometrial ablation (uses microwaves to destroy endometrial lining in a five-minute procedure); pain medications; hormonal agents; lifestyle changes; a progesterone IUD; medications; and HIFUS (High Intensity Frequency Ultrasound), which targets fibroids with an MRI-guided ultrasound system. And Goldberg reports that alternative treatments for conditions that lead many women to hysterectomies are among the best-funded research projects, so we can expect still more options soon.
If there are so many options for women, and so much about the uterus still a mystery, then how did we get here, with hysterectomies the second most common operation that American women undergo?
How Did We Get Here?
After conversations with people who had, and chose not to have, hysterectomies, and with people who perform the operation and who counsel for alternatives, some explanations stand out.
1) Habit. As Goldberg points out, many doctors -- especially older ones -- are accustomed to prescribing hysterectomies for women who don't intend to have more (or any) children and who suffer from reproductive system troubles. "There's an older, paternalistic attitude," Goldberg explains. "'If you're done having kids, let's take the uterus out.' [Other doctors] will bring up alternatives to hysterectomies, and older doctors will scoff at you a little bit, like, why would you suggest anything else?"
The habits of individual doctors aggregate into regional and demographic patterns. The Agency for Healthcare
Research and Quality reports that "women who live in the Southern and
Midwestern areas of the United States, African-American women, and women who
have male gynecologists are more likely to undergo hysterectomies."
2) Lack of information. The doctor may not be aware of alternatives that might allow a woman to avoid a hysterectomy while relieving her symptoms. Or the doctor might not know how to do a procedure. "In Philadelphia, the doctor gets paid about $1200 for a hysterectomy," Goldberg says. "There's an alternative treatment, an embolization, that needs to be performed by a radiologist. So it can come down to economics: if you refer the patient to a radiologist, you lose the financial reimbursement."
Women often lack the information themselves. Judy Norsigian, executive director of Our Bodies Ourselves, says there's "no question that women aren't always getting good information about the implications of a huge surgery."
To explore alternatives and their
consequences, however, takes time. Many women are not willing, or able, to give
that time -- especially when they feel the urgency of their symptoms.
3) Imbalance of authority between doctors and patients. Dr. Clarissa Pinkola Estés's experience illustrates an extreme case. She had a hysterectomy at age 33; she's now 62. "I remember asking, ‘Please, please, help me save my body, so I can have more children," Pinkola Estés says. "I remember as though it happened yesterday, the male doctor literally shouted: ‘You will not dictate to me on matters of medical importance.'"
In less dramatic ways, many of us defer
to medical professionals. Goldberg says "a lot of patients don't want to insult
the doctor with questions," but with information increasingly accessible
online, many people are able empower themselves.
4) It's self-referential. With hysterectomies so common, the operation gains a whiff of normalcy, or is even seen as a rite of passage. Most of us know many people who had a hysterectomy. This, then, comes to seem the sensible alternative if we find ourselves suffering from bleeding, pain, or other symptoms.
Questions about hysterectomies don't exist in a vacuum. There's no doubt that we are informed by an ancient history of valuing women for their ability to bear (male) children. That is, a woman's body, and particularly her reproductive organs, had utilitarian worth and little more. But as Angier reminds us, the uterus may offer countless health benefits to women beyond its essential role in bearing children.
It's foolish to believe that we've overthrown millennia-worth of such sexism in a couple decades. The living legacy of a utilitarian view of women's reproductive organs is apparent in the arguments those who oppose abortion and contraception, where primacy is given to zygotes over the woman they exist within.
We also cannot forget that our country has a chilling history of abuse of women's reproductive systems. Dorothy Roberts has detailed the history of coercive or forced sterilization, often including hysterectomy, of women of color, indigent, and "mentally deficient" women in Killing the Black Body. She writes,
During the 1970s sterilization became the most rapidly growing form of birth control in the United States, rising from 200,000 cases in 1970 to over 700,000 in 1980. It was a common belief among Blacks in the South that Black women were routinely sterilized without the informed consent and for no valid medical reason. Teaching hospitals performed unnecessary hysterectomies on poor Black women as practice for their medical residents. This sort of abuse was so widespread in the South that these operations came to be known as "Mississippi appendectomies."
The prevalence of unwanted hysterectomies led many Black women, in activist Frances Beal's words, to be "afraid to permit any kind of necessary surgery because they know from bitter experience that they are more likely than not to come out of the hospital without their insides."
Sterilization wasn't just used to control African-Americans, but also Native Americans.
"Even the word (‘hysterectomy') just scares me so much and brings up all of these memories," says KL Pereira, a 27-year-old Native woman living in Cambridge, MA, citing a history of doctors using forced sterilization on Native women after difficult births and abortions. Pereira's aunt went in for a D&C treatment for her endometriosis. She expected superfluous tissue to be scraped away; she came out of the operation with a hysterectomy that her doctor decided that she needed.
"Especially for a young girl who was really just learning about her body and the medicalization of it, I felt like I would never trust doctors or hospitals. And I honestly still don't," she says.
This is the context we're in today: a history of coerced and forced hysterectomies is one part of why -- it bears repeating -- hysterectomies have become the second most frequent operation performed on women.
Truly Free Medical Choices
There is no doubt that a good portion of those operations are performed on women who diligently researched, explored alternatives, and partnered with her doctor to come to a mutual decision that a hysterectomy was her best option. There is no doubt that hysterectomies save the lives of many women.
Steve Wilson of Long Beach, CA, considers herself one of them.
"I was totally comfortable having the complete hysterectomy, and haven't been sorry since I did it," Wilson said. "The pathology report came back as pre-cancerous -- was relieved."
Who could blame her? But while we may cheer Wilson for her choice, we must be quite aware that many other women aren't making free choices -- free, in that it is unadulterated by an imbalance of power in the doctor-patient relationship, that the patient has complete and clear information about all options and their consequences, that her doctors are in no way biased towards her because of her color, class, marital status, and interest in bearing children, and that ability to pay in no way limits her options.
Dr. Lori Warren, a gynecologic surgeon in Louisville, KY, is pushing for genuine medical choices for women with her website, BetterHysterectomy.com. Says Dr. Warren: "I truly believe that biggest changes will come through patient education and for women to be empowered to ask for a better, less invasive surgery."
Perhaps the frequency with which hysterectomies are performed is symptomatic of the constrained options women, and all individuals, have in our country's broken health care system. We must expect more from our medical providers. And we can act on those high expectations with persistent questioning, self-education, and a thorough exploration of all treatments.
There's really no other option. Our very bodies are at stake.
How do you tell an awful story to the world?
You can begin by saying it plainly: in the eastern Democratic Republic of Congo, where 5.4 million have been killed in the deadliest war since World War II, women and girls are targeted by a pandemic of sexual violence and rape on a scale never before seen on the planet.
"Often successful in its intent to destroy and exterminate, rape as a weapon of war is causing the near total destruction of women, their families, and their communities," said a recent report from The Enough Project titled Getting Serious About Ending Conflict and Sexual Violence in Congo.
A lot of people are working to alert the world to a gruesome reality that's simmered for more than a decade in silence. But in a global context where humanitarian crises are too common, and where the concerns of both African nations and women are hardly centered in media and government, how can the DRC's story be told to incite compassion in the massive proportions necessary for change?
"In Congo, because of the complexity of the conflict, to get Americans and other overseas people to see what's happening, you have to have a narrative, a hook," said Colin Thomas-Jenson, co-author of The Enough Project's report. "It sounds crude, but you need to draw people in."
The key is, Thomas-Jenson says, to tell the DRC's story so that it triggers "an existing constituency" that will challenge the normalization of sexual violence that targets Congolese women and girls. "With Darfur, the narrative is genocide. The word is so loaded, it tells a story itself. And it immediately activated a certain constituency. The Jewish community was very seized."
Policy and activist efforts, then, are currently focused on grassroots communications strategies -- that is, telling the story of the DRC via blogs, media coverage, film, and research -- with the belief that once people see themselves as part of the story, they will move emphatically towards change.
And in Congo, the initial communications attention is aimed for the constituencies built around women's empowerment. "The narrative that's most compelling here is the victim's perspective. And we see women as the principle victims in Congo," says Thomas-Jenson. With V-Day and Women for Women International championing the human rights of women in eastern Congo, conveying their stories to their partners and beyond, the hope is that a political and humanitarian response will be swift.
Because, Thomas-Jenson emphasizes, more than charity is needed.
Nita Evale, a Congolese woman who is vice chair of Congo Global Action, has chosen to become another one of the storytellers of Congo's crisis.
"Congo is my country and just watching it die slowly wasn't an option any longer," Evale said. "I was waiting for some hero to come and rescue my people but quickly realized that that hero didn't exist. I had to do something to that when a hero ever comes, he will at least find a country to save."
Through CGA, Evale mobilizes a coalition of activist organizations to build awareness and pressure a political response. CGA recently held a legislative advocacy day and workshop series in Washington, D.C. The event connected the rape pandemic with the "raping" of the DRC's land of natural resources, and on governance and post-conflict issues.
It's a storytelling tactic that, Evale said, works. "The conference went really well, even exceeded my expectations," she said.
What are the specific political interventions that might change the DRC's course?
The Enough Project puts forth a plan of peacemaking, protection, punishment, and prevention. It calls for, among many other things, maintaining and consolidating the DRC's ceasefire; increasing the presence of UN peacemakers; the U.S. Senate's passage of the International Violence Against Women Act (S. 2279); and, via funding, vetting, and training, international support for the DRC's security sector reform.
One of the most catalyzing narratives put forth comes via Lisa Jackson's new documentary, The Greatest Silence: Rape in Congo.
The film centers the raped women and girls in eastern DRC who tell the stories that have been largely ignored by the international community. Jackson shared her own story of being gang-raped in Washington D.C. with the Congolese women, and thus built an uncommon intimacy into her film. Jackson also touches on the political context that makes such massive sexual violence possible -- for example, the Rwandan genocide that led thousands of soldiers to cross the DRC's eastern border, and the plundering of diamonds, gold, coltan (a metal used in all cell phones and laptops) and other rich Congolese resources. As well, Jackson brings forth the voices of the rapists in disturbing interviews with young soldiers.
Aired on HBO, winner of a Sundance Festival jury prize, and shown on screens ranging from local documentary festivals to a European Union commission, Jackson's striking film is having an impact.
"Women, and sometimes men, can't get a question out (during the Q&A session) because they're crying so hard," Jackson said. "I can't wait to go back to the Congo. I'm taking pictures of the diverse audiences, and I want to show their reactions to the women in the film. I want to show them that their stories are being heard."
But Jackson says that one of the most common question she hears -- even from avid documentary audiences, who she cites as being particularly aware of world affairs -- is: Why haven't I heard of this before?
"They're shocked at the extent of the catastrophe," Jackson said. "Many of them didn't even know there was a war."
Many bloggers have been activated by Jackson's film. They're writing about eastern Congo's women, developing resource pages for action, and building online collaborations. April 13 was a coordinated day where bloggers of all stripes committed to collectively sharing Congo's story.
Some bloggers wrote in tribute to Jackson's film, others offered contact information for legislators and activist groups, and still others reflected on how the current crisis emerges from a long history of damage.
"If there is anything to take away from the (Jackson's) film, from knowing about this horrific and inexcusable outrage, it's that the women who told their stories survived," wrote the blogger Anxious Black Woman in her April 13 post. "Those women broke their silence. Like our ancestral mothers before them, they found a song or they have created 'a way out of no way.'"
Jackson believes we are only seeing the very beginning of Congo's deep stories reaching a global audience.
"There are other filmmakers who want to do pieces on Congo's conflict, there's blogs and online columns, and a whole new class of art emerging," she said. "I hope people take this up on a grassroots level, by taking money out of investments and, since its now on the congressional record, there are senators and representatives that can be addressed."
But the most important thing?
"Become more informed," Jackson said.
Which means not just being storytellers, but listeners.
Learn more about the story!
News
Blogs
The Greatest Silence Trailer
]]>Prevention
It's funny how the numbers align. Among the 42 million sexually active American women of reproductive age who don't want to become pregnant, 89% use contraception. It's intuitive, then, that plenty of people who oppose legal abortion aren't appalled by birth control.
Laura, a 25-year-old Catholic campus minister in West Virginia, opposes abortion, but her feelings about global warming lead her to part ways with the Church on birth control (while Laura asked that her real name not be used, names used in this article are real unless noted otherwise). The Church's catechism calls contraception "intrinsically evil." But "we, as a country, use so much of the world's resources," Laura says. "We've got to be responsible about how we bring people into this world and especially into this opulent culture." She supports reproductive health access as part of a full-scale reorientation of national priorities toward sustainability. Laura's lived in Jamaica, where she said radio ads promote condom use and musicians talk of HIV/AIDS in their songs. She's also lived in Maine, where emergency contraception is available without parental consent, her public high school offered off-site day care to young parents, and her college gave free condoms to anyone who wanted them. She applauds these efforts as responsible and realistic.
Laura's in good spiritual company: Seventy-eight percent of U.S. Catholics believe the pope should permit contraception. The majority may not be a new development. Catherine (not her real name), a 50-year-old Philadelphia woman who opposes legal abortion, remembers sex education in an all-girls Catholic school in the 1970s as fairly progressive. "To the credit of the teacher, she did explain the basics of sex and pregnancy prevention," Catherine says. "We thought it was rather amazing to be taught about birth control when we weren't supposed to be having sex." These days, Laura, as a modern-day Catholic, says, "the Church has made itself irrelevant on this issue. Its rigid position is not for the good of its people. And it makes it too easy to trivialize the Church on other matters."
Brittany Galisdorfer is a 24-year-old from Detroit who reconciles her support of contraception with her opposition to abortion by taking a scientific perspective. "A lot of people don't support contraception because they believe life starts at conception, which requires egg and sperm to meet," she says. "But you can put egg and sperm together all day without a baby coming together. It needs to attach itself to the uterus to make a baby. That's why contraception is okay. It simply denies the third element required for pregnancy."
The life-begins-at-conception belief fuels the mischaracterization of some methods of hormonal birth control as abortifacients. Anti-choicers often go after emergency contraception -- simply two regular birth control pills taken within 72 hours of intercourse -- in particular, but some organizations would like to ban all hormonal birth controls and IUDs, claiming they cause abortions.
Beth Bovair, a Catholic 24-year-old from Arlington who believes life begins at conception, sees no validity in the birth control platform of organizations that oppose abortion. While she opposes abortion, Beth says we need to build a supportive society before it is no longer an option.
"We have to provide for children and women, and create a society where there's no stigma of pregnancy for women and men," Beth said. And that society, according to Beth, includes access and use of contraception to support family planning.
It's a sentiment that Claire Keyes, co-founder of the Abortion Conversation Project, echoes. "What happens after the child is born?" Claire said. "All our energy and dollars seem to go for having more babies, not caring for them."
Knowledge
Iowa just became the seventeenth state to decline federal funds for abstinence-only education in public schools.
Why the trend?
"Research continues to show that abstinence-only education fails to delay sexual initiation, reduce numbers of sexual partners or prevent pregnancy in adolescents," said Iowa Gov. Chet Culver in Medical News Today.
It's hardly theoretical: While over a billion federal dollars fund abstinence-only education (and zero support comprehensive sex ed), people under 25 have become the fastest-growing category of new HIV infections. A CDC study recently announced that one in four teen girls has a sexually transmitted infection. Eight hundred thousand teens aged 15-19 become pregnant each year. A number of those pregnancies end in abortions.
Given these statistics, Beth Bovair would like to see nuance, not just abstinence, in the classroom. Plenty of students aren't sexually active, so they don't connect to the material, she noted. Brittany echoed the sentiment: "I wasn't planning on having sex until I was married, and most of my friends weren't having sex, so [sex education] didn't feel relevant," Brittany observed. So it's important, Beth said, to provide facts while acknowledging that any given classroom includes people who are sexually active and people who feel far from that experience.
Catherine, the Philadelphia woman struck by her Catholic school sex education, and her husband found their children's sex education in both public and private schools to be "totally inadequate." They became the primary teachers for their children's sexuality education.
These four women are hardly alone in their desire for better classroom experiences. A 2004 Kaiser Foundation nationwide poll found that 85% of parents would like teenagers to receive comprehensive age-appropriate sex education, in lieu of abstinence-only.
Who Represents Them?
Laura, Catherine, Brittany and Beth aren't members of any national anti-abortion organization. Those that are Catholics distinguish their perspectives from Church catechism. Beth is church-hopping in Washington, D.C., looking for a parish where her spiritual and political views have a home. While Laura attended the March for Life in January, she spent much of it with a local friend, indicating that she doesn't feel comfortable among "hardcore" anti-choicers.
Brittany, too, is distanced from the traditionally-portrayed anti-abortion community. "The people who I share (my opposition to abortion) with, I don't share much else," she said.
But the numbers reveal that the conclusions of these women aren't uncommon. Who, then, represents their voices in the public conversation? It's not the groups that challenge reproductive rights at every level. These women -- representing many in their movement -- are left to speak for themselves within a context that begs misunderstandings and mischaracterizations.
"I've never heard anyone say these things, period," Brittany said. "I'm disappointed in the media in particular. There's nothing to do but live my life the way I choose to and speak up when I feel it'll be productive."
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