Should Young Women be Allowed to Choose Sterilization?

Emily Gillingham, Resident Blogger (’15, Michigan State University College of Law)

I’ve been reading a lot lately about the many young women who, after much careful deliberation and research, have concluded that they want to be sterilized- only to be turned down by their doctors.  The story plays out again, and again, and again, on blog after blog.  This is A Thing That Is Happening, and it really burns my toast.  Some doctors are telling women that they won’t perform the procedure until the women are 30 or even 35 years old, in case they decide later that they want kids.

Let me be clear here- there is a long, complicated, and painful history (and present) of sterilization where the woman is being coerced or forced by a person or by the government, or targeted because of her race, class, religion or disability, or lacks informed consent.  I’m talking about women who are being denied the procedure only because their doctors are worried that they will regret it.

For those women, being denied the procedure is frustrating.  As blogger Bri Seeley wrote, “I was livid. I had asked for a procedure for six straight years with no break in my desires, opinions, or beliefs.  Why did the medical community continue to deny me of my personal right to sterilization?”

Sterilization is safer than pregnancy, and actually reduces the risk of ovarian cancer and pelvic inflammatory disease.  It doesn’t increase women’s risk of breast cancer, unlike a certain birth control method might (I’M LOOKING AT YOU, PILL), and it’s reversible in 25% to 87% of cases.  It also leaves some women options like in vitro fertilization and adoption if they decide that they want to have a child and reversal doesn’t take.  Also, although some IUDs and hormonal implants are actually more effective than sterilization, not every method is a good fit for every woman, so making sterilization available to women who want it is important.

If your brain is exploding with the effort of trying to understand why this is happening at a time where the right to choose abortion is being severely restricted, politicians seem to have some sort of bet going about who can be the biggest jerk about restricting contraceptive access, and raising kids is hella expensive, I totally feel you.

I hesitate to blame the medical community, because although studies vary widely on sterilization regret rates, the strongest predictor of regret is young age.

Nonetheless, there is something creepily paternalistic about medical professionals making women who’ve decided that they don’t want kids risk birth control failure for a decade or more, just in case they’re wrong.  After all, some of the research about young age and sterilization regret that the National Institutes of Health points to is based on procedures performed in the 1970s and 1980s, and our attitudes about women’s role in society and the number of women who wish to remain childless have shifted dramatically since then. It would be interesting to see future research focus on women who are denied sterilization procedures. We could learn a lot from the women’s motives, the doctor’s rationales for denial, and demographic data. The most visible blog posts on this subject are written by white women, and there is value in knowing why we aren’t reading women of color blog on this topic.

Denial of sterilization to young women is related to, and perpetuates, the myth that all women want children and that those who do not will change their minds.  As reproductive justice advocates, we should be fighting for doctors to respect women’s personal decisions about sterilization.

Special Prosecution of Women Who Use Drugs During Pregnancy Or … Happy One Month Anniversary Tennessee SB 1391 – and Here I Forgot to Get You a Gift.

Gavin Barney, LSRJ Summer Intern (’16, University of California, Berkeley School of Law)

The start of August marked a somewhat ignominious one month anniversary this year: a short thirty-one days earlier Tennessee became the first state in the union to specifically criminalize drug use during pregnancy. On July 1st, the state enacted SB 1391, which enables prosecutors to bring assault charges on the behalf of a fetus against women who use narcotics while pregnant.  Just over a week later, 26-year-old Mallory Loyola became the first target of the law.

In a twisted kind of way, Tennessee’s approach to criminalizing pregnant women is almost refreshing.  The Volunteer State is by no means the only state to treat drug using and drug addicted pregnant women with prison sentences and loss of parental rights instead of … well … treatment. Not by a long shot. Other states prosecute pregnant women at high levels with three main methods: child abuse and endangerment laws, laws prohibiting delivery of illegal drugs to minors, and fetal murder/manslaughter statutes.

Alabama prosecutes pregnant women in a particularly roundabout and unnerving method. Since 2006, Alabama has arrested at least 100 pregnant women for the crime of “exposing their child to a meth lab” using a chemical endangerment law designed to prosecute people who bring children to dangerous locations. To make matters worse, the Alabama Supreme Court deemed it necessary to affirm this usage of the chemical endangerment laws in back to back years – holding in 2014 that the statute’s use of the word “child” “plainly and unambiguously includes unborn children.”

Medical and public health organization such as the American Medical Association (AMA) and the American Academy of Pediatrics (AAP) have criticized these punitive practices for putting both mothers and fetuses at risk by discouraging women from seeking prenatal care for fear of being turned in.* Additionally, the American College of Obstetricians and Gynecologists (ACOG) has stressed that treatment, not incarceration, must be the approach to these cases.

However, at a broader level, policies like those in Tennessee and Alabama are most horrifying and destructive because they answer the question “are pregnant women still people with full rights?” with an emphatic “hell no they’re not!” Like other personhood-type policies, special criminal prosecutions pits pregnant drug using and addicted women in conflict with their fetus, putting the full force of the law on the fetus’s side (or at least against the woman).

For more information on criminalization of pregnant women, check out LSRJ’s fact sheet on “Regulation of Pregnant Women,” and for LSRJ chapters interested in hosting an event on the issue, LSRJ is releasing an Event Toolkit on Criminalization of Pregnancy and Shackling of Incarnated Pregnant Women.

*Note that fifteen states require health care providers to report suspected drug use during pregnancy.

New Study Debunks Six of the Worst “Myths” About Sex-Selective Abortion

Gavin Barney, LSRJ Summer Intern (’16, University of California, Berkeley School of Law)

The documentary It’s a Girl was released in 2012 to immediate acclaim in traditionally progressive and pro-choice corners – the Amnesty International Film Festival made it an official selection and Ms. Magazine called the movie “unflinching” in its positive review. Fully titled It’s a Girl: the Three Deadliest Words in the World, the film describes the problem of son preference in India and China, telling how, tragically, as many girls are “eliminated” yearly in those countries as are born in the United States. However, the documentary was not quite what it appeared: a 2013 article in Slate uncovered that It’s a Girl was produced with strong, but well hidden, ties to an organization called Harvest Media Ministry that makes anti-choice videos. The film also has a subtle, but real anti-abortion message. The really troubling thing about It’s a Girl is not necessarily who produced it however – anti’s are not automatically incapable of producing material of worth. Rather, the problem is how films like this fit into the narrative of another issue here in the United States: the recent onslaught of “sex-selective abortion” ban legislation that impose criminal penalties on the performance of an abortion sought because of the sex of the fetus.

CaptureLast week I attended a talk coinciding with the release of a new report on the issue of sex-selective abortion bans called “Replacing Myths with Facts.” Produced by Advancing New Standards in Reproductive Health (ANSIRH), National Asian Pacific American Women’s Forum (NAPAWF), and the University of Chicago, the study identifies six common and damaging myths and misconceptions that have allowed sex-selective abortion bans to worm their way into so many legislative sessions. Chief amongst these myths is that male-biased sex ratios “are proof that sex-selective abortions are occurring,” (spoiler: there are other major factors at play) and that the “primary motivation behind laws banning sex-selective abortion in the United States is to prevent gender-based discrimination” (another spoiler: it’s really about restricting access to abortions in general).

The speakers began their presentation by introducing the room to It’s a Girl. It was suggested at the talk, and I am inclined to agree, that one of the reasons both that It’s a Girl has been a hit among pro-choice people and that anti-choice organizations and politicians have so aggressively pushed sex-selective abortion bans is that the issue of sex selection is particularly uncomfortable for pro-choice folks. The notion that people would be actively choosing boy babies over girl babies, and acting on those choices, is disturbing to any person with even the broadest feminist beliefs. Additionally, recent technological innovations that potentially open the door to allowing people to use artificial reproductive technologies to choose traits, including sex, for so-called “designer babies” make questions of sex preference more current and significant. In light of these realities, it is not terribly surprising that many normally pro-choice people may be willing to start carving out exceptions to abortion access – and it is equally unsurprising that racial stereotypes and misconceptions have played a major role.

This, of course, is where “Replacing Myths with Facts” comes in. In its introduction, “Replacing Myths” explains how proponents of sex-selective abortion bans focus on “the problem of ‘missing women’ in China and India in particular” to justify their policies. They rely on and reinforce stereotypes that people in the Asian and Pacific Island community bring these presences and practices to the US. This is myth #5 that “Replacing Myths” debunks: the most recent studies have found that foreign born Chinese, Indians, and Koreans actually “have more girls overall than white Americans.” This is a particularly important myth to debunk because the way the laws are designed – putting the onus on the health care provider to deny abortions based on son preference with the threat of criminal sanctions –opens the door to doctors generally denying API women abortions out of stereotype fueled fear.

Sex-selective abortion bans have become an extremely prevalent tactic to limit abortion access, and the fact that these policies are based heavily on racist stereotypes and spread by playing on people’s racial misconceptions make this an issue of particular import to supporters of reproductive justice. I encourage you to read “Replacing Myths with Facts” and to inoculate yourself as best you can against the lies around sex-selective abortion.

Pregnant in a War Zone

Sasha Young, LSRJ Summer Intern (’16, Northwestern School of Law)

A couple of years ago a dear friend of mine had her dream wedding “back home” in Palestine. She’s now battling the Atlanta heat through her first pregnancy, and with the recent surge in violence in the Occupied Territories, I thought for the first time what it would have been like for her to be pregnant “back home.”  The Occupied Palestinian Territories are fraught with human rights situations. I’ve thought about many of the different aspects before, but before I imagined my friend, I had never really taken a reproductive justice lens to the conflict. Immediately, my mind jumped from sexual assault, to access to abortion services, to getting maternity care in a place where sanitary napkins were only recently removed from the list of blockaded items.

The implications for pregnant women are predictably scary. An investigation into the 2008-2009 siege in Gaza revealed horrifying stories of women walking for miles through heavy shelling to find safe places to deliver. Hospitals prioritize the injured, travel is nearly impossible, and physicians are overwhelmed by trauma injuries. One woman, Dalal, recounted her doctor shouting at her for putting the ambulance driver’s life at risk when she should have delivered at home. Another woman, Rula, recounted walking alone for more than an hour in active labor only to be turned away from the hospital because there were too many injured people and not enough staff. Another report found that between 2000 and 2007, ten per cent of pregnant Palestinian women in the Occupied Territories were forced to give birth while stopped at Israeli checkpoints. Of the 69 documented births, 35 babies and 5 mothers died.

Obviously Occupied Palestine is not the only place where women are pregnant and give birth under violent and dangerous conditions. Stories like these are undoubtedly repeated throughout Syria, Congo, Timor, and every conflict zone in between. The immediate trauma of violent conflict leaves practically everything else as “collateral damage” of war, but I suppose this is just a little known bullet point on a long list of reasons we need a sustainable solution to the conflict in Israel and Palestine.

The Changing Abortion Conversation in Latin America and the Caribbean

Sasha Young, LSRJ Summer Intern (’16, Northwestern School of Law)

I recently saw a film that caught me by surprise, “La Espera” (released in the States as images“Expecting”) by Chilean filmmaker Francisca Fuenzalida. The film is devoted to one night, when Natalia and Rodrigo, a teenage couple from Santiago, self-induce an abortion with Misoprostol. The film was released in 2011 to critical praise for great filmmaking and the courage to tackle the subject of abortion in a country with one of the strictest abortion bans in the world.

Earlier this year I traveled to Chile, the skinny country that lines the western coast of South America, with a bit of angst over what I would find. I wondered what a country that in the last 50 years had a socialist president, a revolution, and a dictator [who, despite his human rights violations, brought incredible economic development and one of the most oppressive abortion laws in the world] would actually look like. I’d heard stories from friends about their own botched Misoprostol abortions, and I’d read about little Belén, the 11-year-old girl who was raped by her mother’s partner and then praised by the former president for deciding to continue her pregnancy. What I found was a country where, although it’s not uncommon to see hormonal teens passionately rolling around the manicured lawns of el Cerro Santa Lucía or see street art cursing the bourgeoisie, the conversation about abortion is hard to find.

I worked in an abortion clinic in Bogotá, lived beside an abortion clinic in Mexico City, and marched to stop restrictions on reproductive rights in Atlanta. I’m from a little island where abortion is still illegal, but even there in Aruba, the conversation of abortion happens. So I was really excited a few weeks ago to hear a debate happening around new Chilean president Michelle Bachelet’s plans to introduce therapeutic abortion exceptions to Chile’s abortion law later this year. The controversial president is a physician by profession, a single mother of three children, and possibly made of steel considering the political risk she’s taking with this new initiative. Abortion is a controversial topic, but in a region with one of the highest rates of teenage pregnancy, where bad abortions are the leading killer of young women, and where criminal penalties for abortion disproportionately affect poor women, we have to at least have a conversation about what reproductive justice in our region looks like.  The winds are changing throughout Latin America and the Caribbean, and having an open and honest conversation is the first step to achieving equal access to tools that help us decide when, how, why, and if we want to parent.

 

Reproductive Oppression Comes at a Cost, Literally

Grace Ramsay, LSRJ Summer Reproductive Rights Activist Service Corps (RRASC) Intern (’16, Smith College)

In 2010, I needed emergency contraception.  Asking my moms (yes, moms) for help was out of the question. So, I waited in the CVS parking lot while my 18 year old friend bought it for me because I was sixteen and Plan B was not yet over the counter. If my friend had said no, if I couldn’t afford the $50 upfront charge, or if I lived in a different state, there’s a good chance I wouldn’t have gotten the morning after pill at all.

Contraception access should not depend on your age, your provider or pharmacist’s religious beliefs, or the employer you work for. Naturally, I was dismayed to see the Supreme Court decision that allows corporations to refuse birth control coverage on religious grounds.  Justice Ruth Bader Ginsberg  reminds us that reproductive oppression comes at a cost, literally: “It bears note in this regard that the cost of an IUD is nearly equivalent to a month’s full-time pay for workers earning the minimum wage.” 

My snarky feminist side can’t help but wonder, (as so many have already lamented,) how come Hobby Lobby still covers vasectomies and Viagra? And why are condoms are available at practically any store, to any age, but it took until last year to have OTC emergency contraception? Can it be as simple and paternalistic as men not wanting women to have control over their personal reproductive decisions? I’m trying to remain hopeful that the outpouring of negative response to the Hobby Lobby decision will translate into renewed activism for reproductive justice.  In the meantime, I have to keep remembering that progress does not move in a linear direction and we have to keep up the good fight.

Birth Control vs. Population Control, and Why it Matters

Grace Ramsay, LSRJ Summer Reproductive Rights Activist Service Corps (RRASC) Intern (’16, Smith College)

Earlier this month, I attended a discussion hosted by Population Action International, NARAL, and the Ibis Foundation, addressing the global gag rule and its effects on reproductive health worldwide.  Basically, the gag rule is a U.S. executive policy that prevents any countries receiving U.S. family planning aid from offering abortion services, even if the country wants to use its own funds to do so.  It was created under the Reagan administration – every Democratic president has since reversed it, and every Republican president has reinstated it.  It’s a clear anti-choice policy that has disastrous effects on family planning initiatives worldwide.

During the talk, the NARAL representative alluded to allying with environmental action groups.  When birth control advocates/family planning initiatives “go abroad” and team up with environmentalists, I tend to get concerned.  The language can quickly move away from the need for universal access to the variety of contraceptive methods and instead focus on how developing nations are “irresponsibly reproducing”.   So often I hear rhetoric like, Lower birth rates will put less strain on our natural resources! Or, We’re reaching our carrying capacity!  Such statements are especially misleading because the U.S. actually consumes more natural resources than developing countries.  I was pleasantly surprised that this talk kept its focus on ensuring the right to family planning for all women.

As a person who cares about RJ, I absolutely support the right to global contraceptive access and I also think it’s really important to take a nuanced look at the way we talk about population control in relationship to birth control access, in the light of the U.S.’s own eugenic history.

Let’s not forget that not one generation ago we were forcing sterilization upon disabled people, incarcerated people, and poor people, in an attempt to create a more “fit” American population.

Let’s not forget that in the 1970s, African American and Puerto Rican women were disproportionately sterilized without their consent.  Meanwhile, white women were campaigning for the right to birth control.

Let’s not forget that the United States knowingly sold the dangerous Dalkon Shield contraceptive to developing countries, after it was removed for sale in America.

Let’s not forget that the reproductive justice movement aims for the freedom to choose when and how to have a family (or not).   When we introduce anything else into the equation – even for the sake of “saving our planet” – it becomes coercive.  If we shift away from this concept for the sake of “saving our planet” we lose the voices that matter most: the people in the population.  And if replacement population rates become the end goal for contraception distribution, rather than enabling women’s agency and autonomy worldwide, we’re at risk of replicating our eugenic past (and present).  Population control efforts and RJ efforts may both create the same result (a lower population), but to me, intent is what matters most.

Anti-shackling Laws and Fetal Rights – Finding the Common Ground

Deodonne Bhattarai, Resident Blogger (’12, Northeastern University School of Law)

The “Birthing Justice” panel at the recent Civil Liberties and Public Policy Conference at Hampshire College celebrated Massachusetts’ recent success in passing an anti-shackling bill.  It also highlighted the dangers inherent in treating pregnant people differently from non-pregnant people. These two issues, at first seemingly at odds with each other, point to an important lesson for those pursuing the protection of pregnant people forced to give birth while in state or federal custody – as important as anti-shacking laws are, it is crucial that they be drafted using language that empowers the pregnant woman rather than in a way that protects the unborn fetus.

Fetal separateness laws ultimately convey legal rights upon the fetus, often from the moment of conception. As Lynn Paltrow, Executive Director and founder of National Advocates for Pregnant Women has explained, there is no way to grant rights to an egg, embryo, or fetus without diminishing the rights of the pregnant person. Over the last three decades, hundreds of women have been charged with crimes due to pregnancy related conduct and we have seen the application of existing criminal and civil child protection laws upon pregnant women in unprecedented ways.

For example, pregnant women who test positive for drugs have been charged with assault with a deadly weapon – the deadly weapon in these cases is the drug and the assault is the in-utero transmission of that drug from the woman to her fetus. Pregnant women have also been charged with contributing to the delinquency of a minor, unlawful child neglect, and child endangerment. Even women participating in government sponsored methadone programs have had their newborns taken away due to in-utero “abuse” when the baby tested positive for the drug. Certain conduct including attempted suicide as well as being HIV positive, has subjected pregnant women to charges of murder, feticide, and sentencing enhancement triggers. Late last month, Tennessee passed the nation’s furthest reaching law, a law that subjects any woman struggling with drug addiction to criminal prosecution based upon her pregnancy outcome.

The creative application of laws upon pregnant people is not only destructive to maintaining family unity but is also counterproductive in assisting with any mental health issues or drug addictions the pregnant person might have.  As Paltrow explained in a recent interview with NPR, “The biggest threats to life, born and unborn, do not come from mothers. They come from poverty, barriers to health care, persistent racism, environmental hazards and prosecutions like these that will frighten women away from getting help from the problems they do have.”

The shackling of pregnant, laboring, and post-natal inmates has been outlawed in eighteen states. When asked about Massachusetts’ pending legislation, Megan Amundson, executive director of NARAL Pro-Choice Massachusetts stated, “Shackling pregnant women is unsafe and inhumane, and it is shocking that this barbaric practice continues today.”  As prisoners rights advocates understand, shackling any human, pregnant or not, is inhumane and barbaric but while we wait for greater criminal justice reforms, we must remain vigilant.  As anti-shacking legislation continues to gain momentum, it is incumbent upon reproductive justice advocates to ensure that such laws are constructed carefully so as to protect women’s rights while avoiding language that would strengthen fetal separateness jurisprudence. For not only do fetal rights laws potentially curtail abortion rights by establishing dangerous precedent but they also create a maternal-fetal conflict by pitting the woman’s autonomy, right to privacy, and right to bodily integrity against those of her fetus.

Getty Images & The Lean In Collection – There’s Room to Lean Further

Deodonne Bhattarai, Resident Blogger (’12, Northeastern University School of Law)

Last month Getty Images, in collaboration with Facebook CEO Sheryl Sandberg’s LeanIn.org nonprofit foundation, launched over 2,500 new stock images aimed at depicting “female leadership in contemporary work and life”. As a collection, the images are a beautifully composed collage of picture perfect women, girls, families, and friendship. However, taken individually, some of the images may perpetuate a problematic oversimplification of what it takes for women to thrive in the corporate world.

A number of the images play with the work/life balance motif, showing thin, stylish women in contemporary work and home office settings.  In an interview with NPR, Getty’s Pamela Grossman discussed how these images were intended to present an updated and more dynamic vision of motherhood.

“The older model would be that … the mother looked incredibly harried, and she would be juggling a dinner plate in one hand and a baby in the other. Sometimes even more arms would be Photoshopped onto her to show just how indeed she was juggling it all.”  Grossman compared this outdated model of a multitasking mom with that depicted in the LeanIn Collection, “They really feel like they have contemporary style, and they’re engaged and energetic.”

Although the intent behind the collection is admirable, it is hard not to question whether this contemporary view of working mothers may be setting an unobtainable bar for those of us contemplating or trying to balance motherhood with a career.  In a country where income inequality continues to grow and women face a wage gap of $.77 to every dollar earned by a man, where most lack access to paid maternity leave, where the glass ceiling and maternal wall are still very much intact for women pursuing corporate leadership, and where female attorneys represent less than one-third of lawyers at law firms (a number that has actually been dropping for the past four years), the new Collection presents a picture that is hard to reconcile with the reality working mothers face.

Many of the images of working mothers show them sitting at their immaculate desks, working on their laptops while young children balance on their knee or sit serenely nearby. How do these women manage to keep their children from grabbing at the laptops, pouring coffee over the keyboards or pulling on their dangly earrings and perfectly coiffed hair?  Where are these women supposed to be?  Certainly not at work-I have no data on this but I bet there are more dog friendly offices in the U.S. than child friendly.  So are these mothers supposed to be representing the women who are fortunate enough to have a flexible working schedule that allows them to work from home? If so, they must be wealthy enough to afford housekeeping because their offices are immaculate with few or no toys in sight for their perfectly behaved children.

Although the collection does include women of various ethnic backgrounds and ages, it fails to move past the model thin and designer dressed. The idea of a more “contemporary” working mother is nice, but at the end of the day these are stock photos used to depict artificial scenarios in order to sell a product or service, or to communicate a point of view or sentiment..

To claim that the Collection serves a loftier dual purpose is an overreach and I question whether these images of the “contemporary” working mother are actually an improvement upon the traditional multi-armed multitasking mother. What woman can possibly live up to the unrealistic standards these images depict while trying to succeed in a world where working women continue to be discriminated against because they are mothers. The Collection’s embrace of the unrealistic while touting it as “empowering,” left me feeling just the opposite – how will I ever be able to obtain such a lifestyle while balancing my legal career with the needs of my family?

Would I trust my partner with birth control?

Melissa Torres-Montoya, Resident Blogger (’11, University of California, Berkeley School of Law)

Would I trust my partner with birth control?  Thinking of past partners the answer would have to be; yes, yes, no, maybe, absolutely not.  Which I guess mean that my answer to that question has changed over the years so it really depends. With technological breakthroughs and the eventuality of a male birth control, this is a question that will be contemplated more and more often.

Vogue recently published a story on their website where one man shared he and his wife’s exploration of this question.  While he brings up some interesting points, issues that I’m sure will cross the minds of many when tackling this question, their exploration of a male using birth control mostly reenforces gendered stereotypes, lacks real acknowledgment of how each relationship is unique as is their decisions about how to control their fertility.  When the writer of this Vogue profile & platform piece describes how he and his wife discussed the idea of a male in control of birth control more generally than just within their own relationship, he describes how his wife found the idea of “putting a male in charge of contraception” “amusing,” even suggesting “that putting the male in charge of contraception would just embolden him to have sex with random women, and riskier sex at that; unlike a condom, the pill would do nothing to prevent disease.”  Not surprisingly, these same concerns were expressed when a female birth control pill was developed.  These are also some of the same concerns that are currently being expressed about PrEP, a daily pill that works sort of like birth control but instead to reduce the likelihood of HIV transmission rather than pregnancy.  I won’t argue that social norms around sex haven’t entirely changed since the advent of the birth control pill, and while some conservatives would argue the family system has broken down, I think it’s pretty evident that monogamous relationships, marriage and family units still remain the overwhelming norm even while most women at one point in their lives use a form of contraception.  The birth control pill and other new contraceptive options have revolutionized sexual agency, allows couple’s to plan pregnancies and has been instrumental in women being able to enter into the work force.  Both PrEP and the male birth control pill could provide similarly positive social benefits.

Sure, there could be the instance where both people in a couple slip up on their pill, thinking they have double protection because they’re both using a form of birth control.  And maybe we might have to redouble sex education efforts to make sure that everyone ACTUALLY knows the only way to prevent STIs is through condom use.  But the addition of a male birth control pill as a contraceptive option, allows more individuals to take control of their fertility, allowing them to choose when and whether they ever want to become parents.  Similarly, while PrEP may not be a medication that should be recommended for everyone, it does offer one more avenue for people to engage in sexual activity while safeguarding their sexual health by reducing the likelihood that they will become HIV+.  I, for one, am all for developing more options that allow for sexual agency and overall improve the public’s health, as well as pushing forward a society in which we trust both men and women to each take actions to protect their sexual and reproductive health.