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.

 

5 Reproductive Justice Resolutions You Can Adopt in 2014

Ruth Dawson, Resident Blogger (’12, Emory University School of Law)

These days, it seems that there is a list for everything: 29 Ways to Love Being 29, 10 Ways to Prevent Yourself from Alien Abduction, Top 5 Trite New Year’s Resolutions, etc. etc.  At the risk of sounding preachy, here are 5 reproductive justice-related resolutions that I have adopted for 2014.

  1. Be sex positive – It sounds so easy in theory.  But sometimes when one is faced with a friend or younger sibling and sexuality, the “ick factor” takes over.  Breathe deeply and feel emboldened by the thought that you may be the only person your little brother can talk to about such things.
  2. Examine and reevaluate your privilege – In social justice spaces, it is crucial that folks commit to evaluating and dismantling their own privilege, which can be based on race, class, gender, and various other identities.  It can be difficult to focus on these structural concerns while caught up in exciting work.  But our movement cannot truly achieve our aims without such rigorous self-reflection and holding ourselves accountable.
  3. Raise your voice – I often find myself horrified by news articles these days: people denied their rights, or stripped of agency and subjugated to an employer’s or hospital’s religious directives.  This is the year to write a blog post or Op-Ed in the local paper, and raise your RJ voice.
  4. Practice what you preach – Women’s health folks know the importance of preventive care and of prioritizing one’s health.  But we don’t always schedule the tests, screenings, and health care into our own schedules as we advocate others to do.  2014 is the year to lead by example.
  5. Be kind to yourself – At the same time, advocates have to be kind to themselves in the same way they are to others.  Often, I find that it is advocates who are hardest on themselves.  I have a friends who is a safe sex advocate, and when she contracted an STI, self-imposed a layer of shame upon an already tough situation.  While RJ advocates hold themselves up to a high standard, it’s important to leave some flexibility, some room to be kind and gentle to oneself.

Happy New Year, all!

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.

Enough with smooshing already! (Part 1)

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

The term “smoosh” –slang for sex– was brought into the general public’s lexicon through that disaster of hit MTV reality show, Jersey Shore.  Sound silly? Possibly even degrading?  Well, then some would say it’s an apt reflection of the Jersey Shore casts’ outlook on sex.  Don Jon, a film written and directed by Joseph Gordon Levitt opened in theaters September 27 and seems at first glance to bring this “smooshing” culture to the big screen.

Similar to Jersey Shore, the film plays on ridiculing the absurdity of Jersey Shore culture, mostly though, the film provides social commentary in a poignant and delightfully entertaining way. The film explores themes of sexual individuality and sexual freedom.  Everyone enjoys sex differently and sexual freedom is a critical right we must, as a society, safeguard in order to pave the way for each individual to fully explore their sexuality. The movie seems to propose the question; can there be a point where our sexual freedom in fact hinders our sexual individuality?  Namely, does addiction to internet pornography stifle enjoyment and exploration of actual sex?  Gordon-Levitt’s movie suggests that it can.  Moreover, the depiction of sex in most pornogaphy might have a detrimental impact not only on sexual individuality but gender equity.  In Gordon-Levitt’s own words, “The message Don Jon is trying to bring to light—and make fun of—is reducing people, especially women, to nothing but sex objects.”   I appreciate this message.  And any film that tries to tackle gender equity usually gets my seal of approval.  I also love that it tries to remind its audience of a timeless observation; that sex is most importantly about connecting in a genuine and intimate way with another person. 

Stop blurring the line

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

I’ve read the varying commentary on blurred lines; ranging from the song is “kind of rapey” to defenders that wrote, in fact, Robin Thicke’s song is allowing for the woman to take the initiative, “go ahead” get at him girl! I think, like most women, I landed somewhere in the middle.  Such lyrics of the song like proclaiming that “she” wanted him but “she’s” actually a a good girl bothered me because it draws a distinct line between a woman’s sexual desires and how she had to behave in order to still be seen as a “good girl” that feel unjustified and confining.  Some of the lyrics also just felt outright appalling; “just let me liberate you”? Thanks Robin Thicke, we women, have been waiting for you and your catchy pop lyrics to liberate us.  Finally, I probably fall in the minority in finding the title of the song also problematic.  I’m a pretty direct person, particularly in the matters of the heart and lust, so dealing with blurred lines just isn’t my thing.  And maybe if, as a society, we were taught to be more open about our feelings and desires then there would be less instances of blurred lines. I acknowledge, however, that this is not how the romantic lives of many operate. The phrase blurred lines is something many relate to and as long as blurring the lines doesn’t mean “well she said no but she really seemed to be acting like yes,” then I don’t really have a problem with the phrase. It is possible that the intent was to refer to blurred lines as being that period when both parties are trying to figure out whether they are interested in each other and not the worrisome “rapey” interpretation of blurred lines?

In any case, while the title of the song and these particular lyrics bothered me, mostly, I found the song catchy and not really a call to arms to perpetuate a problematic rape culture.  If the song came on at a party or after a late night happy hour, I would, along with most of my girlfriends, jump up to dance to it.

Now the video was a whole other matter.  I just couldn’t get behind it or understand it’s deeper “parody” meaning the artists’ claim they had in developing it. The video, to me, just looked demeaning and not even entertaining.

That’s why when these Auckland law students came out with this parody, I found it absolutely brilliant!  Their parodying lyrics are sharp, witty, insightful and their video highlights exactly how absurd and demeaning Robin Thicke & co’s original video was.  Thanks Aukland law students for a video that identifies the misogynistic nature of sexuality in our society and reminds us, no men can’t just grab us, that’s a #sexcrime! (And Kudos for garnering more attention to gender equality and #Liberation)

Religion and Reproductive Justice: A Personal Story

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

I am a law student at the University of Oregon but this weekend I ventured out of the northwest and attended LSRJ’s northeast regional conference at Harvard Law, hosted by the Harvard Law Students for Reproductive Justice.  At the conference, one of the panels was entitled RJ and Religion: Whose Conscience Matters?  The speakers all did a wonderful job of unraveling the complexities of reproductive justice issues through a religious lens. 

The first speaker from Mergerwatch Project enlightened me on the issues that arise from a hospital’s merger with a religious affiliated organization.  Her talk was great!  But I most identified with the last two speakers from Catholics for Choice and a Unitarian Universalist minister.  Due to my Catholic upbringing I have both the blessing and the curse of the religion’s teachings.  A baptized and confirmed Catholic, I have an understanding of the Bible that many others don’t have and less useful perhaps, I know the words to a number of hymnals and know when to kneel and make the sign of the holy trinity during mass.  One of the “curses” of being a Catholic, for me, was being brought up to believe that a woman who exercises her right not to have children (by way of an abortion or use of EC like Plan B) is killing a life and must be excommunicated.  Additionally, the Catholic teachings taught me that sex was a dirty word and that the only intercourse should be between a husband (a man) and his wife (a woman) in their marital bed…for the sole purpose of procreating.  This all got complicated for me during my teen years.  You see, I began to feel as though the religion was incompatible with my personal beliefs.  I embraced my sexuality and felt that it was something that didn’t belong solely to the married hetero man and woman.  I struggled, trying out different churches, searching for one that I better identified with.  I didn’t find the elusive church that I longed for but I did find fellowship.  First, it was among my theater friends in high school and then with my fellow nerdy English majors, and finally, alongside other LSRJ warriors.

What I have discovered and what the speakers at the LSRJ conference highlighted is that reproductive justice doesn’t have to conflict with your religion.  Rather, RJ can exist in harmony with your faith.  The speakers reiterated something that most folks already acknowledge – religious leaders, even though they may say they are, are not always speaking for their constituents.  This is particularly true for Catholic bishops (Only 7% of Catholic voters believe strongly that Catholics have an obligation to vote only for candidates who are recommended by the Catholic bishops).

I am no longer a practicing Catholic but I don’t see this as a sad ending to the story of my religious quest.  I see this as a moment of personal recognition.  I recognized as a young adult that Catholicism did not align with my personal needs or beliefs.  It was later in adulthood that I came to realized that organized religion in general did not agree with my faith.  My story is personal and my story is a happy story.  I feel blessed to have been raised in a Catholic environment; there are so many good things that came from it.  However, I also feel blessed to have realized at a fairly young age what did and did not work for me when it came to religion and faith.  Having engaged in self-discovery, I feel better prepared to speak to others about RJ issues through a religious/faith-based lens and understand the struggles that some folks feel when navigating the worlds of RJ and religion.  I hope that along with the speakers that I met today, I can help others to understand that they don’t have to choose religion or RJ but can embrace both comfortably knowing they are not alone. 

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.

 

Stop yelling “SEX!” when you don’t have the answers

Elisabeth Smith, Resident Blogger (’14, University of Washington School of Law)

On Saturday night, Bill O’Reilly and Jon Stewart debated each other in “The Rumble 2012.”  Bill’s opening statement concluded as follows: “The poster person for the entitlement society is Sandra Fluke.  Do you know Sandra? I left two tickets for Sandra plus a month’s supply of birth control pills at will call. Is she here tonight? Sandra, buy your own. Coupon. We shouldn’t be paying for this or a lot of other stuff.”  He also held up a sign reading “Buy.  Your.  Own.”

This talking point is old. Rush Limbaugh first called Ms. Fluke a slut on February 29, 2012. Since then, she’s graduated from Georgetown Law (where she was the GULC LSRJ President), spoken at the DNC, and campaigned for President Obama.

Let’s remember what she said to Congress though.  Sandra Fluke testified about the need for her insurance plan to cover contraceptives. Not once did she ask for you, or me, or anyone else to pay for birth control.  In fact, she didn’t even talk about her own need for contraceptives, but rather her friends who couldn’t afford it, including one with polycystic ovarian syndrome who needs to take birth control to stops cysts from growing on her ovaries.

How did these women’s medical decisions morph into a stubborn story of insatiable sexual appetite and demands for free birth control? AND, p.s., who cares if someone has an insatiable sexual appetite?! Frankly, sex-shaming is obvious and tired. Why won’t this story die? Why can’t Bill O’Reilly get his facts right? Why does he keep retelling his version of Ms. Fluke’s testimony?

I don’t know. I really don’t. But the image of Bill O’Reilly, deliberately, patronizingly, slowly scolding Ms. Fluke from afar “Buy. Your. Own” while holding a three word sign makes me apoplectic. She spoke honestly and compassionately about the religiously-imposed limitations of her health insurance plan and the resulting effects on specific individuals.

So, Bill, stop talking about Ms. Fluke. Stop using her name as an applause line. Stop with the authoritative, demeaning tone. And, while you’re at it, check out this study.  It turns out free birth control is actually a pretty great thing.

 

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?