Making Sexual Health a Part of the Health Discussion

Jamille Fields, Resident Blogger (’13, St Louis University School of Law)

The health care provider’s office is intended to be a confidential space for health discussions. It should be a place where all can discuss personal health issues as they arise, or practices to prevent health issues from arising. Conversations on sex and sexuality should be among these health discussions throughout youth. Education on sexuality has been shown to increase contraception use, reduce adolescent pregnancy rate, and reduce the risk of sexually transmitted diseases. But sadly, sexual health often is not discussed with youth in the provider’s office.

Earlier this year, the Journal of the American Medical Association published a study, documenting–perhaps for the first time–sexual health discussions occurring in physicians’ offices.  The study observed adolescent patients’ visits and found nearly one-third of physicians did not discuss sexual health. For those that did have sexual health discussions, the conversations lasted only 36 seconds. Now, count out 36 seconds and see how much of a “discussion” you can have.

In 36 seconds, one certainly cannot have a discussion that includes the full range of topics recommended. The American Academy of Pediatrics’ Bright Futures Guidelines for Health Supervisions of Infants, Children, and Adolescents recommends that sexuality education be provided from infancy to 21 years old. These recommendations include teaching the proper name of genitalia to young children. As children grow older, the discussions should include hygiene, privacy, and sexual development. By adolescence, these conversations should advance to counseling on contraceptives, HIV and STD prevention, and counseling against domestic violence. Notice, these conversations do not start in adolescence – the ground work should have been laid since infancy.

Failure to provide children and adolescents education on sexual health can also violate Medicaid and some Children’s Health Insurance Program (CHIP) rules. Specifically, the required benefit for those younger than 21 years old enrolled in Medicaid and some CHIPs includes medical screenings. And health education is a required component of each medical screen. This education must encourage a healthy lifestyle, be forward-looking and age-appropriate. As the Bright Futures recommendations indicate, age-appropriate health education must include sexuality education.

Unfortunately, children and adolescents are not receiving screenings as the law requires. A 2010 report from the Department of Health and Human Services notes that 76% of youth did not receive the required screening. And even when the screening did occur, it often failed to include any health education (over 20% screened did not receive any health education). So clearly changes must be made.

Thanks to the Affordable Care Act (ACA) sexuality education is also now a clear requirement for children and adolescents enrolled in Marketplace (Exchange) plans. The ACA requires most individual and group health plans to cover certain preventive services. One such service is sexuality education as Bright Futures recommends.

The explicit coverage requirements are an important first step to ensure that sexuality education and counseling are included in health care delivery. However, efforts should not stop there. Changes in the health care system must be made to ensure this actually occurs. To encourage these conversations, I offered recommendations in an issue brief and on a webinar LSRJ and American University hosted.

 

“Do you have a [female] condom?”

Rhiannon DiClemente (’16, Temple University Beasley School of Law)

In case you missed it, September 16 marked the third anniversary of Global Female Condom Day.  Two decades since its introduction, the female condom hasn’t quite lived up to its potential.  Today, less than two percent of all condoms distributed worldwide are female condoms.  When our LSRJ chapter asks local organizations to donate condoms, we are usually sent boxes full of male condoms.  On the rare chance that we do get sent a few token female condoms, they are often met with skepticism and laughter from the student body.

It’s true—the female condom is less intuitive and less familiar than the male condom.  Some may call it aesthetically unappealing and technically difficult to master, but we shouldn’t give up on the female condom just yet…

The female condom is the only woman-initiated technology that prevents both unintended pregnancy and sexually transmitted infections (STIs), making it an important tool in the fight against the spread of HIV.  Women now account for more than half of the world’s population living with HIV.  Worldwide, HIV and AIDS is the number one cause of death for women of reproductive age.  In Sub- Saharan Africa, 72% of new infections among young people age 15 to 24 are women.

Despite these facts, I can’t even give these female condoms away to fellow students.  Only 13% of people have heard of the female condom, and much fewer have ever used one.  However, organizations like PATH, a global health non-profit, are working to reinvent the female condom.  In 2012, the United Nations Population Fund released a new version of the female condom.  The Gates Foundation has also awarded grants for a “next-generation condom,” male or female, that would be easier and more pleasurable to use.  This is an important step.  Greater variety in female condoms can help increase the odds that women even choose to use, or at least try, any female condom at all.

But putting more female condoms on the shelves is not enough.  Advocates need to create education campaigns at the local, national, and global levels on the benefits of female condoms, including the fact that they give women the power to control safe-sex negotiation.

As an LSRJ chapter leader, I hope to start a larger conversation about the benefits, and shortcomings, of the female condom.  I want to encourage women, including myself, to at least try one before we form an opinion about it.  I want men to be involved in this discussion as well; there is no reason a man shouldn’t introduce a female condom to his partner.  Normalizing female condoms in a conversation about pleasurable and safe sex is an important first step.  With informed feedback, the unattractive, clumsy female condom can only get better.

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.

Comprehensive sex ed is essential, not “too racy” for youth

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

2014 brought many fresh starts for me, most predominately the start of a new job in HIV/AIDs policy.  I spent much of my first week at my job better familiarizing myself with HIV/AIDs policy by plowing through many research studies and reports.

I happened upon a report by the Center for American Progress and my alma mater UC Berkeley School of Law exploring barriers to prevention and treatment of HIV among communities of color; making the case for a holistic approach to eliminate racial disparities in HIV/AIDs.  The report includes a recommendation for free comprehensive sex education. While comprehensive sex ed seems like a given for combating the epidemic of HIV, the report notes that despite the effectiveness of sex education, “conservatives have often opposed programs such as condom education and distribution.”  Such opposition to comprehensive sex education has led to “abstinence-only” education, most notably in the South, where the report also noted that the prevalence of abstinence-only education likely contributes in part to why residents of the South are  “significantly less likely to obtain treatment to [HIV] once infected” than people in all other parts of the U.S.

It did not take long for the reality of this to come to light for me, as the same day I read this report one of the top stories in my google alerts was about how some parents in Charlotte, North Carolina find a sex education curriculum “too racy”to be taught at large to their ninth grade students because it includes a chapter entitled “How to Make Condoms Fun and Pleasurable.”  Teaching about how condoms can be fun and pleasurable is an effort to increase use of condoms among teens engaging in sexual activity to prevent unplanned pregnancy and transmission of HIV and other STIs.  Including a section in sex education curriculum that presents condoms in a way that tried to increase their use is a valuable and essential because it promotes safer sex practices among teens and the adults they will grow up to become.

As a former Law Students for Reproductive Justice fellow, it is obvious to me how reproductive justice intersects with health equity and justice issues, I only wish all policy makers and parents alike did too.

Taking the Morality out of Abstinence

Mangala Kanayson, Resident Blogger (’15, Emory University School of Law)

In our quest to destroy the virgin/whore dichotomy by de-vilifying those who do not conform to or believe in the idea that abstinence equates with inherent moral worth, we may inadvertently alienate those who do happen to conform to (but not necessarily believe in) this ideal. This presents the danger of continuing to play into the dichotomy while simply switching the moral values assigned to each role instead of destroying both roles completely and allowing women to assign moral worth to themselves on their own terms.

Perhaps because abstinence is so often considered an ineffectual waiting period rather than a tool (like a condom or an HPV vaccine) that one uses to acquire and maintain a level of security while achieving one’s goals, it is easily glossed over in conversations about sexual health and as a result is presented as a non-option for “normal” and “sexually healthy” individuals.

One harsh result of this inadvertent oversight is that aside from reiterating the media’s insistence that having sex must be our primary concern (billboards in a major city or ten minutes watching television will confirm this), it teaches those who have ever had a previous sexual encounter, whether consensual or not, that continued sexual activity is always the healthy course of action moving forward. Reclaiming one’s sexuality in the case of rape or other sexual trauma takes various forms as unique as the individual doing the reclaiming, but here the dismissal of abstinence as a valid and affirming decision actually limits the choices of survivors.

As much as we want to be sex-positive, we must not forget to affirm the importance of choice. The type of birth control a person chooses to use should not define her worth as a person, and the decision not to have sex should be just as validated as the decision to be sexually active. It’s high time we stopped aiming for extremes and began focusing on aligning in the center, away from competing notions of sexual liberation versus sexual repression. Let’s take the morality out of abstinence.

Moving Backwards: Silver Screen Portrayal of Teen Sexuality

Rosie Wang, Resident Blogger (’14, Columbia Law School)

A week or so ago, my classmates and I were arguing one of the most pressing questions of our nostalgia-obsessed generation: What is ultimate high school movie – Clueless or Mean Girls? (Answer: Neither, it’s obviously Heathers.) Amid the heady discussion and subsequent teen movie marathon planning, I started thinking about how high school movies have portrayed teen sexuality, contraception, and pregnancy over the years. In so many of the teen movies I grew up watching, sex was something that characters are obsessed with and defined by, and pregnancy is the ultimate horror. But is this moralizing cast on teen movies a modern thing? Maybe so.

One of my favorite teen movies is the cult classic, Fast Times at Ridgemont High (FTaRH). For a film that came out in 1982 – smack dab between two landslide election wins for Reagan – it’s shockingly open-minded. One of the main characters, Stacy, is a 15 year old freshman. She has sex for the first time with a 26 year old man and then initiates an encounter with a classmate, Mike Damone, from which she gets pregnant. She decides to get an abortion and tells Damone that he owes her half of the fee and a ride to the clinic. When Damone turns out to be a flake, Stacy’s brother deduces what has happened. He picks her up from the clinic, agrees to keep it a secret from their parents, and takes her out for lunch. Her best friend get revenge by vandalizing Damone’s car and locker in a classic act of high school public humiliation. Stacy, rather than being ostracized or shamed, is shown as being supported by her social circle and loved ones. It is Damone who is ridiculed for shirking his responsibilities, not Stacy for being sexually active. Stacy shows no signs of trauma and the abortion is never brought up again. Instead her narrative becomes one of her blossoming romance with Rat, a boy who has long harbored a crush on her. Rat angrily brushes aside Damone’s veiled insult that Stacy is “a very aggressive girl” (undertones of slut-shaming fully in force). Stacy continues to be assertive by giving Rat a picture of herself with her phone number on it and kissing him. Her reputation, as well as her confidence in herself and her sexuality is unshaken and unpunished.

I can only imagine the outcry such a story line would cause now. It’s a testament to how much we’ve gone backwards to imagine the complaints that would hound FTaRH for giving teens license to have wild, unprotected sex because the movies told them there’d be no penalties! The climate we live in today even mistakenly accused Juno, a movie in which the young woman chooses adoption rather than abortion, of glamorizing teen sex without consequences. In reality, teen pregnancy and teen moms face a great deal of stigma that is racially charged and makes it difficult to continue their education.

Turning to a classic of the aughts, Mean Girls is a film that has people endlessly quoting and referencing it eight years later. It was written by Tina Fey who promisingly said last week, “If I have to listen to one more gray-faced man with a two-dollar haircut explain to me what rape is, I’m going lose my mind.” And Mean Girls does have some golden reproductive justice moments. For example, it makes fun of a health curriculum that tells students that they’ll die if they have sex (taught by a teacher later revealed to be in a relationship with an underage student no less). And yet it leaves some things to be desired. When arch-Mean Girl Regina is in her bedroom with her boyfriend, her mother pops in and asks, “You guys need anything? Some snacks? A condom? Let me know!” It’s part of a larger characterization of Regina’s cold personality resulting from a dysfunctional family in which her mother sets no boundaries because she wants to be a “cool mom.” But is it really being a bad mother to make sure your daughter is equipped to deal with her sexual decisions rather than trying to control her sexuality? Not according to the way many families treat teen sexuality in the Netherlands. Apparently acknowledging that teens have sex, having open communication about contraceptives, and allowing sleepovers actually encourages trust and responsibility rather than the opposite.

Even if Hollywood is unlikely to portray teen sexuality in this way anytime soon (because of both conservative backlash and the lack of narrative drama), hopefully the actual experiences of American teenagers can begin to approach it.

 

Just in Time for Halloween… Fake Hymens!

Josie Sustaire, Resident Blogger (’14, University of Oregon School of Law)

There have been few times in my life that I have thought about my hymen.  Somehow, it just hasn’t come up in conversation.  I wasn’t aware that I had essentially taken its existence for granted until my friend introduced me to the artificial hymen.  My immediate reaction was giggling, followed by more giggling, followed by disgust, and ending with contemplation.  And I’m still contemplating.  For me, the idea of the artificial hymen is completely offensive.  To think that virginity can be bought for $29.95 or that virginity even matters enough to necessitate faking is ridiculous to me.  Particularly after reading descriptions of the “device,” I realized that gummy, fake blood-gushing artifices that you wedge into your vagina aren’t my style.

What I didn’t take into consideration while I giggled and then turned my nose up at the artificial hymen was the reality that for some women in the world, virginity is no joke.  While my friends and I can giggle over the idea of faking chastity, a number of countries permit “honor killings” of women who lose their virginity before marriage.  Women in Egypt, Turkey, Iraq, and a whole host of other countries are under threat of being asked or in most cases forced to undergo a virginity examination.  These tests, as one can imagine, are highly invasive and demoralizing examinations of the woman’s hymen in search of signs that she is no longer chaste.

After all these hymen considerations, a friend brought to my attention yet another.  What about the virgins?  “What about them,” I asked rather clueless.  She then confided that she was a virgin and as much as she might have enjoyed giggling along with the rest of us, inside she felt as though the joke was on her.  As shocked as I was at the idea of the fake hymen, I was just as shocked at the idea of the 25 year-old virgin.  But why?  In the world we live in, it seems, she has surmounted incredible odds with her chastity intact.  But only to feel inadequate?  I say enough is enough.

Fake hymen or real hymen we need to stop defining ourselves by them.  I won’t get into comparatives among males and females (I would be here all day).  The fact of the matter is that men have rarely, if ever, fallen under the scrutiny that women face.  A woman is more than her hymen.

 

Here we go again

Josie Sustaire, Resident Blogger (’14, University of Oregon School of Law)

Scrolling down the news feed of my Facebook account, I stumbled upon a headline that caught my eye.  The headline warned, “New York Schools Enable Sexually Active Teenagers.”  Interesting, I thought, that someone thinks teens need enabling in this department.  I thought that hormones took care of that (but what do I know).  Curious, I read on.  The article discussed New York City’s CATCH program.  CATCH stands for Connecting Adolescents To Comprehensive Healthcare.  The program aims at providing students with free comprehensive contraception.  What struck me wasn’t the fact that savvy NY schools were providing comprehensive contraceptive services to their students but the spin that the media was putting on it by attempting to incite fear in their readers.  To be fair, no all the headlines I encountered were bad.  Here is a compilation of various headlines from a variety of news organizations:

  1. New York City Gives Plan B contraceptive to Teens in School
  2. New York schools enable sexually active teenagers
  3. New York City Pilot Program Offers Contraceptives to High School Students
  4. More Access to Contraceptives in City Schools  (The New York Times)
  5. Girls age 14 can get birth control at New York City schools
  6. Plan B Contraception pills now available at 13 New York City high schools
  7. Morning-after pills offered to NYC high school students
  8. Sensible Plan to Prevent Teen Pregnancy Sure to Be Met With Outrage

What stood out to me were articles #2 and #5.  My reaction to them was a mixture of disgust and sadness.  I thought, “Oh no.  Here we go again.”

Now, I wasn’t around during the sexual revolution of the 60’s, but rumor has it that things got kind of heated when sex education was first adopted into public schools.  The media back then also used incendiary headlines and fear-inducing language to spin stories with the hopes of inciting readers (parents) to action (getting rid of sex education).  Life magazine ran an article in its September 19, 1969 issue addressing just this issue.  On the cover are the innocent faces of grade-schoolers under the headline: Sex Education for our Little Children.  The article discussed, among other things, how parent groups had distributed pamphlets with outrageous stories of other schools around the country.  They claimed that one schoolteacher had taken her clothes off in front of students and that another school had shown sex films, neither of which really occurred.  As silly as these claims may seem, the reaction in the 1960’s to sex education in public schools seems to be repeated each time public schools bulk up their comprehensiveness in regards to sex education or sexual health services.  It happened in the 80’s (or in early 90’s if you lived in rural Oregon like me) in reaction to the AIDS crisis and it will likely happen again.

The bottom line is this: articles focused mainly on inducing fear aren’t helpful.  If anything, articles like #s 2 and 5 are simply knee-jerk reactions to changes that some folks just can’t understand or simply refuse to accept.  And although I may not know exactly what enables sexual activity among teens, I do know this, inciting fear in the hearts and minds of parents is wrong and as a mother of two school-aged kids the last thing that I need is more to worry about.

Off to the Races

Rosie Wang, Resident Blogger (’14, Columbia Law School)

What do you get when you combine two cucumbers, five bananas, chocolate chip cookies, and over 50 condoms? Apparently a good deal of awkwardness.

Let’s back up. It was the day of my law school’s student organization fair and dozens of tables had been set up, laden with activities and treats to lure 1Ls to listen to our pitches. With beautiful sunny September weather, free beer abounding, and high spirits, it seemed like the perfect opportunity to relax and have fun. Arranged on our LSRJ table were goodie bags filled with homemade cookies, lip balm, condoms, lube, stickers, and cards with trivia on reproductive justice. For our activity, we had a simple competition: a race to see who could put a condom on a phallic piece of produce, correctly, and with the greatest speed. We thought it would be eye-catching and hilarious, and we indeed got many emails for our membership list and witnessed some truly impressive feats of speed. But we also encountered some unexpected reactions. I’m not talking about declining to race, preferring just to chat, or walking by with skeptical glances.

What was surprising was hearing multiple variations on the theme of “No thanks, what if someone puts the condom on really fast? You’d know they had a lot of practice!” This was always voiced with a tone of misgiving, as it was apparently a badge of disgrace to reveal you were experienced, rather than a neutral fact or even point of pride that you knew how to practice safe sex. Sure, it’s understandable that one might be concerned with what others would glean from your private life simply by witnessing how you handle a cucumber. People have different comfort levels, and the whole point of reproductive justice is that everyone’s own sexual expression is their own choice. However, when it comes to creating an association of slut shaming, I have to wonder at the strange society we live in where sex as an idea is omnipresent, glorified, and commodified, and yet to a significant extent, people shy away from admitting they have it or talking about the important logistics of it.

However, open dialogue is crucial because the statistics are sobering. Fifty-five million dollars of federal funding will go towards abstinence-only education in 2012. Half of the 18.9 million new cases of STIs each year are made up of 15 to 24 year olds although they only represent a quarter of the sexually active population. Thirty-one percent of new HIV infections each year are made up of 13 to 29 year olds. And 39.8% of high school students did not use a condom the last time they had intercourse. If law students can’t shed the associations of sex and shame, how can we shape society to make it safer for young people who don’t have the benefit of our education, years, and experience?

The Repro Rundown

If you haven’t yet heard, Asian Communities for Reproductive Justice is now Forward Together: So All Families Can Thrive. Evelyn Shen, Executive Director of Forward Together describes changes over the years, the new name, and why “Forward Together” encompasses who they are.

Radical feminist nuns being shunned by the Vatican, too rich.

Our own Sabrina Andrus was a speaker for “Our Bodies are Beautiful, Our Bodies are Political” a panel at the Civil Liberties and Public Policy Conference in Amherst last week!

After some controversy, the creator and writer of the new HBO series ‘Girls’ may have learned that there is no such thing as ironic racism.

PSA: safe sex for Seniors!