Teach them the Way: The Role of Sexuality Education in Preventing Sexual and Domestic Violence

Jamille Fields, Resident Blogger (Law Students for Reproductive Justice Fellow at the National Health Law Program)

The infamous TMZ video showing Ray Rice, a 5’8’’, 206 pound-football player punching his then-fiancée (now wife) out, the University of Montana at Missoula being dubbed “America’s Rape Capital” after at least 80 rapes were reported on campus within the last three years, the recent New Jersey high school football hazing scandal that resulted in three players being charged with various sexual assault crimes. Despite making recent headlines, sexual and domestic violence are unfortunately nothing new. To me, these instances indicate that we are not effectively teaching youth what constitutes a healthy relationship and acceptable sexual behavior. Youth then carry this lack of knowledge into adulthood.

Last month, I wrote about sexuality education in health care delivery, and this month I would like to pick up where I left off. There, I discussed how to help adolescents gain greater sexual health knowledge. But what is often overlooked is the important role sexuality education has in preventing sexual and domestic violence.

Young children are vulnerable to sexual abuse from teachers, parents, and other adults with whom they have a trust relationship. A recent United Nations Children’s Fund report correctly noted younger children are less likely to comprehend what is considered abuse. Sexuality education can teach children what constitutes inappropriate touching and behavior.

Adolescents in informal or dating relationships can be just as vulnerable to intimate partner violence as adults. Adolescents are often new to relationships and romantic feelings, and not knowing how to cope with these new feelings may lead them to physically act out against their mates. Their mates often don’t know how to respond to this physical abuse. Seventy percent of 15 to 19 year old adolescent girls who have been the victims of physical or sexual violence never sought help. The reasons vary, and include not understanding the abuse was a problem. Boys who experience abuse are even less likely to seek help due to stigma. LGTBQ youth and others who don’t conform to gender norms often become the targets of violence. Sexuality education can teach the signs of abusive relationships and healthy forms of sexual expression. Sexuality education should also include information on sexual orientation, and the sexual health education provided should be inclusive of same-sex relationships and sex.

Those who have unhealthy relationships during adolescence are more likely to have unhealthy relationships in adulthood. It is estimated that 1 in 4 women will experience domestic abuse, but it is hard to get an accurate estimate given that domestic violence often goes unreported. Youth who witness violence at home are more likely to be victims of domestic or sexual violence as adults. Also, youth who have been sexually abused in early childhood are at a higher risk of being exploited in sex work and engaging in unsafe sex practices later in life. For all of these reasons, counseling against sexual and domestic violence must begin long before adulthood.

October was domestic violence awareness month, so it is an apt time for these conversations to begin, but it should not be where these conversations end. Sexuality education both in classrooms and providers’ offices offer the opportunity to prevent violence before it makes it to TMZ.

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.

The Texas Threat

Anne Keyworth, Resident Blogger (’16, North Carolina Central University)

Last week we received some news worth raising our hopes for.  The Supreme Court restored the decision of a Texas district court, which found several abortion restrictions, including policies regarding admitting privileges and medically induced abortions, to have an “undue burden” on women.  This effectively allowed 13 abortion clinics to reopen, and is reason to celebrate.  The 6-3 split suggests that the court is cognizant of the gravity of this legislation and is cautious of its potential impact.

However, this fight is not over.  If the law moves forward in its full form, it would pose a serious threat to Texan women’s access to safe abortion facilities.  Worse still, this law could pave the way for other states in the south and across the nation to enact similarly restrictive legislation.

The outcome of this case will largely be based on the interpretation of what an “undue burden” means in the context of abortion restrictions.  There is little precedent on this, and therefore depends on the how the judges at the next level interpret such a phrase, and eventually on the swing votes at the Supreme Court, if it hears the case down the road.  This could lead to a great reproductive justice victory if the courts rule that restrictions on admitting privileges and medically induced abortions are not beneficial to women’s health but rather are placing superfluous obstacles in their path to accessing abortion care.  A favorable ruling at the circuit level would set precedent for the most conservative circuit in the nation, and a ruling at the Supreme Court would set nationwide precedent.  An unfavorable ruling, on the other hand, could open the floodgates to a plethora of destructive legislation that could have devastating effects on women.

To date, the Supreme Court has not addressed the specific issues faced in this suit and, while Justice Kennedy and Chief Justice Roberts voted to restore the district court’s decision and temporarily disallow the restrictions, there is no indication that they would vote to overturn the law and block the restrictions if the case ends up on their docket.  Justice Kennedy, the main swing vote on the court, has not voted to protect abortion rights since Planned Parenthood v.  Casey in 1992; rather, he has voted to uphold 20 of the 21 abortion restrictions that have come before him.

While Texas is in flux, several of their clinics have reopened after the Supreme Court’s ruling last week.  However, some were not able to reopen because they either they believed they would not be able to conform to the new standards or they had already taken irreversible measures in reaction to these standards.  Additionally, the back and forth nature of this legislation has caused a great deal of trouble and anguish for Texas women whose healthcare choices should not be in a constant political sway.  Let’s hope that Texas women will prevail and will not be deprived of access to the full range of safe, legal healthcare options every woman should unquestionably be entitled to.

Sexual Rights and the Post-2015 Agenda: A Call to Action

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

Sexuality, a source of pleasure and well-being, is, for many, a central aspect of being human. Over the past twenty years, tremendous strides have been made in the engagement of human rights with sexuality. Despite this progress, global actors—notably the United States—have not accepted a clear definition of sexual rights. As the international community begins to outline the post-2015 sustainable development goals, sexual rights must be enshrined in this new agenda.

Sexual rights embrace human rights that are already recognized in national laws, international human rights documents and consensus statements. The most commonly cited definition of sexual rights was created by the World Health Organization:

[Sexual rights] include the right of all persons, free of coercion, discrimination and violence, to: (1) the highest attainable standard of sexual health, including access to sexual and reproductive health care services; (2) seek, receive and impart information related to sexuality; (3) sexuality education; (4) respect for bodily integrity; (5) choose their partner; (6) decide to be sexually active or not; (7) consensual sexual relations; (8) consensual marriage; (9) decide whether or not, and when, to have children; and (10) pursue a satisfying, safe and pleasurable sexual life.

Sexual rights are a unifying force for important reproductive justice issues and a core element of sustainable development. Claims to sexual rights have emerged from distinct and often disjointed conversations on sexual violence against women, sexual and reproductive health, HIV/AIDS, and LGBT advocacy. Around the globe, new initiatives advancing sexual rights demonstrate the centrifugal forces at work. The Yogyakarta Principles outline rights related to sexual orientation and gender identity; the Latin American and Caribbean Committee for the Defense of Women’s Rights Campaign adopts a feminist analysis of patriarchy; and the International Planned Parenthood Federation declaration adopts a sexual health focus. Acceptance and advancement of sexual rights is essential to combat extreme movements—justified through religion, culture, and nationalism—that seek to impose a narrow view of sexuality and reproduction through laws, policy, and global development work.

Despite the fact that the U.S. government has endeavored to support women raped in conflict and to promote the rights of LGBT persons globally, it has failed to acknowledge that sexual rights exist—let alone advance them. The failure of the U.S. government to accept a definition of sexual rights and promote those rights within foreign policy initiatives undermines its own goals. This is a critical moment for the United States to live up to its promises and protect sexual rights for all. Just as the U.S. took the lead in crafting the definition of reproductive rights agreed to in 1994 at the International Conference on Population and Development, the U.S. must demonstrate leadership on advancing agreements on sexual rights. This is a call to action—U.S. government: ensure that everyone, everywhere, can exercise their freedom to live in dignity—recognize sexual rights!

It’s Up to the Courts to Block Alabama’s Extreme Parental Involvement Law

Abbey Marr is a Law Students for Reproductive Justice Fellow at Advocates for Youth

Last week, the American Civil Liberties Union sued the state of Alabama on behalf of one of its only abortion clinics to block a new parental involvement law that could put some young people on trial simply for seeking abortion care. Alabama’s restriction is one of the worst laws in a huge, nasty pile of laws passed by state legislatures to put obstacles in the way of people – particularly poor people, people of color, and young people – who are seeking abortions.

Parental involvement laws require that when people under eighteen seek abortion care, they notify or get consent from one or both parents first. Most young people seeking abortions do involve their parents, but there are a variety of reasons that is not always possible. In fact, one study found that thirty percent of pregnant teens who do not tell their parents about their abortions make that decision because they fear violence or being kicked out of their homes. Young people who are not threatened with abuse in their homes may be afraid to let their families down or uncomfortable involving their parents. Yet, under these laws in order to get around the parental involvement requirement a person has to file an petition to the court for a “judicial bypass” saying that the person is mature enough to make the decision to get an abortion – petitions judges can and do reject. Parental involvement laws delay access to abortion, endanger health and safety, and fundamentally disrespect young people’s ability to make their own decisions. Unfortunately, the Supreme Court upheld just such a law in the early 1990s, and 38 states have adopted them. Alabama has required people under 18 to get the signature of one parent or legal guardian since 1987.

This past year, however, Alabama passed a new law that is unimaginably worse. As the ACLU wrote in its brief to the court, the law “radically alters the judicial bypass process in a wholly unprecedented manner that goes well beyond any judicial bypass statute that has ever been upheld by a federal court.” Now, when a person under 18 petitions for a judicial bypass, the District Attorney is automatically notified, and the court may appoint an advocate for the fetus (Yes, you read that right!). Further, if the person’s parents know of the bypass proceeding already, the court must allow them to participate. The District Attorney, fetus, and parents may call any witnesses they want to testify against the person’s petition – including witnesses who may be the very reason the person has chosen to ask for a judicial bypass in the first place, such as an abusive partner or family member. With this law, Alabama is literally putting young people who need abortion care on trial.

It is best for young people who find themselves pregnant to be able to seek the advice of a trained medical professional rather than face the situation alone and afraid. Further, young people should have the same right to access the full range of reproductive and sexual health services that other people have. That right includes the ability to access reproductive and sexual health services confidentially and with dignity. It does not include being put on trial to get the services they need. The Alabama legislature seems to have forgotten this, but hopefully the courts have not.

This blog has been cross-posted on Advocates for Youth’s youth activist site amplifyyourvoice.org

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.

 

My Professor, the Genius

Amy Krupinski, Resident Blogger (’14, William Mitchell College of Law)

Probably by now, you’ve heard about the MacArthur Foundation Fellows, aka the Genius grant recipients.  If not, you can review the Geniuses here. In my last year of law school, I approached Professor Sarah Deer, who I knew would be teaching my feminist jurisprudence class in the spring semester, about a paper topic that would blend my interests: access to contraceptives and reducing the unintended pregnancy rate with some new element reflective of current needs that hopefully I’d be able to identify with her help. I knew full well she’d steer me in the direction of Native women and their access to emergency contraceptives—I just didn’t anticipate the overall effect it would have on me. Needless to say, from the first book she lent me to begin my research on emergency contraceptive access through Indian Health Services, I became completely invested in the project.

I had spent a lot of time researching emergency contraception access on a state level when I lived in Colorado, so I already knew many of the basics—it’s expensive, it’s often stored behind the counter (if it’s stocked at all), and there is a stigma associated with its acquisition, especially in small towns. I read all the books she loaned to me, dozens of scholarly articles she had collected over the years, and eventually finished a paper that not only am I happy to have researched and written for my own person growth, but in order to take a topic she wanted explored and produce something worth sharing.

Now, I am proud to say that she has molded and shaped my legal education, which I hope to maintain throughout my entire legal career. I would have been proud anyway, but she is an unstoppable force and her work has received (in my opinion) a fraction of the commendation it deserves. Because of her encouragement, insight, and guidance, I know the overall direction I want my career to go, I became a better feminist, and most importantly, I learned from her when to be angry, how to turn that anger into something productive, and when to accept people for who they are.

Regressive Voting Policies Emerging Across the Nation

Anne Keyworth, Resident Blogger (’16, North Carolina Central University)

There are few things more priceless in a democratic society than the notion that our vote is just as valuable and important as the next person’s.  My generation has grown up with a firm understanding of the fact that we have a right to vote, we should vote, and, depending on who we are, we may be encouraged to vote.  We have lived through some historic elections and have indeed witnessed the value each vote can have in battleground states.  For decades, there has been a consistent shift in voting laws and policies, making it easier and more convenient for voters to register and cast their ballot.  Many states now offer early voting and same day registration in an effort to increase voter participation.

But voting rights in many states are currently under attack, and in states like mine, it has become nothing less than a battle to protect every person’s vote.  Voter ID laws and placing limits on early voting are ways many states are working to make it more challenging for certain groups to exercise their right to vote.  Here in North Carolina, a destructive collection of changes to our voting laws were passed in 2013 in merely two days.  Prior to these changes, we had 17 days of early voting, same day registration, allowed for provisional ballots, allowed 17 year olds to register, and did not require a photo identification at the polls.  These are measures that North Carolinians have become accustomed to and that have been heavily relied upon in recent elections.  All of this changed last year and, if left in place, these limitations will have a profound impact on the outcome of our elections and therefore the composition of our state legislature, and potentially the control of the US Senate this year.  What limitations like this do is further marginalize communities of color and low income families, who are already underrepresented and who historically have had more difficulty securing their vote.

These changes are not unique to North Carolina.  They represent a major regression in what had long been a national trend of making voting more accessible, more convenient, and more reachable by more people.  If these efforts are not stopped, they will deeply compromise the integrity of the American political system and the notion that each citizen’s vote is as important as the next.  Entire groups of people will feel as though there are organized efforts to suppress their participation in our democratic process. In a system where our vote is our voice, this will send destructive and polarizing messages to a significant portion of our electorate.

The implications of this year’s election are far reaching, and that’s why I hope that groups like Law Students for Reproductive Justice can mobilize our peers and ensure that people understand and appreciate the value their vote has.  If we show up to the polls, we will show that we are here to fight back and win this battle to protect each person’s vote.

“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.

Oral Contraceptives and Why We Shouldn’t Count Out Over-The-Counter

SJ Chapman, Resident Blogger (12, Northwestern University Law School)

Recently, some Republican candidates have entered the spotlight for doing a 180 on issues of contraceptive access. Take Congressman Cory Gardner (R-Col.) for example.  Gardner has a sinister record when it comes to matters of reproductive justice.  However, in a recent op-ed, Gardner argued for over-the-counter availability of oral contraceptives.

Practically overnight, leery reproductive justice advocates leapt to attack this position, denouncing it as an insidious political tactic to ultimately decrease access to oral contraceptives.  The logic goes like this: oral contraceptives are widely available without a copay under the Affordable Care Act, but would be costly (as much as $600 a year) OTC.  Women who had previously been able to access oral contraceptives thanks to the ACA would be squeezed out due to the price.

I have to say, although I am against most of Gardner’s positions on reproductive justice, this one might not be as bad as we’ve made it out to be.  In countries where oral contraceptives are sold, most already offer them OTC.  Even Planned Parenthood advocates for OTC oral contraception in the United States.  And I have to wonder – when drugs have gone OTC in the past, there have still been prescription-only versions.  Wouldn’t this be the case with birth control as well?

Even though it comes from someone with history of deplorable stances on reproductive justice, maybe we shouldn’t be so quick to denigrate this one.