Tuesday, November 25, 2008

“…To go far, go together.”

Recently I stood listening to Al Gore speak to Harvard students about global warming and climate control. He began his speech by saying that overpopulation had contributed to the problems we are now experiencing. The solution, he said, started with educating girls, empowering women, giving them the chance to control their own fertility and giving them opportunity. When women have opportunity, they limit the number of children they have. On a day focused on “green” issues, it was good to hear the vice president reference the empowerment of women.

Later he said something else I think speaks to the coalition we are building in Iowa as we reduce the number of unintended pregnancies among 18-30 year olds and create a model for states and the federal government.

The vice president quoted an African proverb which says “If you want to go fast, go alone. If you want to go far, go together.”

For me personally, the Iowa Initiative has been gratifying work. My most productive professional work has happened as a result of grassroots coalition building.

With a new president-elect, we are at a turning point in our country’s future. A change in leadership at the national level will influence our ability to create a positive climate in Iowa.

I’m excited to see how, here in Iowa, just how far we can go, together!

Friday, November 21, 2008

Please, Have a Conversation...

Most Iowans I talk with are surprised to learn that we are 48th in the country in terms of access to family planning and birth control. I was surprised, too. In Mt. Pleasant I lived three blocks from the Southeast Iowa Planned Parenthood clinic, so I thought everyone else in Iowa had access.

The Iowa Department of Public Health contracts with Iowa Rural Health Clinic Providers to deliver primary care, including reproductive services. Women on Medicaid can get reproductive health services at these rural health clinics in counties where there is no family planning clinic. I have come to realize that access is more complicated than that.

In cities like Des Moines or Davenport a woman might not have access if she has no car and the local bus doesn’t stop near a clinic. Recently the Visiting Nurses of Des Moines opened a family planning clinic at Park Fair Mall Shopping Center, right next to the Fareway grocery and the Walgreens pharmacy on the local bus line.

In fact, they advertise in the Des Moines buses. The ads are important because if women don’t know about the three new kinds of long-acting reversible contraceptives, then they aren’t really accessible.

If a woman lives in Lyon County or Taylor County and there are no family planning clinics within 30 miles, then access is a problem, because most women work, sometimes on shifts that make it inconvenient to access birth control and reproductive health services on a regular basis.

Because of Iowa Initiative grants, existing clinics are opening satellites. A few weeks ago Northeast Iowa Community Action opened clinics in Postville, Fayette and New Hampton. Next week we’ll be opening Planned Parenthood of Greater Iowa clinics in Creston and Ft. Dodge.
Access also includes access to information. We created the first comprehensive map of family planning/birth control clinics in the state, so that anyone visiting our website may click on the town where they live and get contact information. In some cases they can make an appointment online. The Initiative also created a comprehensive chart of all hormonal and non-hormonal birth control options now available in most clinics across Iowa. It's also been translated to Spanish, because language can be a barrier to access.

When I was newly married, I was making $7,000 a year as a teacher in small town upstate New York. I had health insurance, but it didn’t cover birth control. I couldn’t afford to be pregnant those first three years of marriage, because I was supporting us while my husband finished law school. The nearest family planning clinic was 30 miles away, but that’s where I had access to low-cost birth control pills and a yearly check up. If a woman has no health insurance or has health insurance that doesn’t cover birth control, access is a problem.

Today the Pill can cost between $30-50 a month. College students and many women working minimum-wage jobs, simply can’t afford this expense. Iowa Initiative grants make long-acting reversible contraceptives (LARC) available at no-cost or low cost at every family planning clinic on our map. So far the best advertising for new clinics and LARC in Iowa is word-of mouth: roommates sharing information; daughters telling their moms; health care professionals counseling clients.

Please have a conversation with someone else about what you learn here.

Wednesday, November 12, 2008

U.S. 29th in Infant Mortality?

On Sunday, October 18, a New York Times editorial called “shameful” how poorly the United States compares with other industrialized countries in its infant mortality rate. The Times reports that in l960 we were 12th and now we’re 29th. The editorial says it’s difficult to pinpoint the causes because infant mortality is linked with health and economic status of the mother, her race or ethnicity, access to quality medical care as well as obesity and drug use.

While we’re overhauling the health care system maybe we could take a look at where we can integrate age-appropriate sexuality education from kindergarten through college.

If we can help women learn to prepare their bodies for pregnancy, educate them about contraceptive methods that will allow them to plan their pregnancies and space them with enough time to recover, we can reduce the mortality rate.

The Guttmacher Institute numbers show that the mortality rate goes up when women have babies too close together for their bodies to heal and strengthen. At the family level, the school level, the community level, in faith-based organizations and among elected decision makers, we must make women’s reproductive healthcare a higher priority than polarizing ideologies.

Ads Help Make Family Planning Mainstream

I remember seeing the first ads for feminine hygiene products on television and wincing. “Is there nothing private any longer,” I wondered. We now have ads for Viagra and “happy periods.” For someone like me who grew up in a family where we didn’t talk about any body parts we can’t see, this was unsettling. But the more I think about it, the more I think it’s a good thing, because advertising is helping us get over our sexual taboos.

In my job with the Iowa Initiative, I am working with family planning clinics which are starting to advertise their services and the new long-acting reversible contraceptives (LARC), which not too many women yet know exist. As a result, I think these ads will help us get used to the fact that family planning clinics are as Main Street as the local doctor’s office or the local pharmacy.

In Cedar Rapids, for instance, at all the local theaters, viewers see the Coke and popcorn ads, but they also see the ad for a local family planning clinic. In Ottumwa, the local clinic advertises on billboards and park benches at busy intersections. In Harlan, there’s a banner on the local hospital. In Des Moines, you can learn about long-acting reversible contraceptives on local buses.

At a clinic in Council Bluffs, the phone at the clinic starts ringing right after the staff hears the popular Planned Parenthood “bunny” ad airing on local TV.

These ads are part of a public conversation we need to be having about health care options which includes preventing unintended pregnancies among adult women.

Family Planning Clinic Openings

Now the young woman is living with her fiancé who is a medical student. When they first became sexually active, she decided to go to the Planned Parenthood in her community, but she kept putting it off. She knew she needed to take responsibility for averting an unintended pregnancy, but somehow she felt guilty about going to the clinic to get birth control. She found it ironic that she felt bad about doing something responsible.

For this reason it’s important that we make family planning clinics so mainstream, so Main Street that there is no stigma attached to walking in the front door.

Earlier this year, when I opened one of the first family planning clinics funded by the Iowa Initiative in Cedar Rapids, Waverly and Independence, I was surprised to find the Chamber of Commerce ambassadors, the mayors, city council members and county supervisors in attendance.

The family planning clinic in small town Waverly is on Main Street near a dance studio. It struck me that in Waverly little girls will learn to be physically and emotionally strong as they learn the power of their bodies, and when they’re young adults they’ll go next door to assure that they continue to be physically and emotionally healthy and strong as they learn the power of their adult bodies.

In small town Independence the new family planning clinic is located in the local hospital between the wellness center and the nursing home. Again, local leaders were there to welcome this small business to the community.

Recently in Postville, a local early childhood teacher brought her high school class to the family planning clinic opening. One of her students was pregnant. They all learned about the services the clinic offers, including yearly exams and testing for sexually transmitted diseases as well as birth control counseling.

Earlier that day we opened a clinic in New Hampton, where a local reporter in her 40’s was visibly pregnant. She and her husband already have several children. She laughed about the fact that she had made an appointment to get one of the new, long-acting IUD’s, but when she went for the insertion, they discovered she is pregnant. She and her husband are anticipating the arrival of their baby and she’s comfortable telling her story to strangers.

Wednesday, November 5, 2008

If the President-Elect Can Talk About It, We Can Talk About It Too

Barak Obama, our new president-elect, co-sponsored the HR 1709 [109th]: Prevention First Act in the Senate during the 2007-2008 Legislative Session, a bill which seeks to expand access to preventative health care services that reduce unintended pregnancies, reduce the number of abortions, and improve access to women’s health care. President-Elect Obama talked openly about issues regarding women’s reproductive healthcare during the campaign, concentrating on reducing unintended pregnancies. This bodes well for the future of issues covered in the Prevention First Act.

Yesterday’s election is promising for those of us committed to starting community conversations about how we improve access to birth control and reproductive health services for adult women. If our next president can talk about it, so should we.

HR 1709 [109th]: Prevention First Act Summary: The bill includes provisions to:

  • Increase access to family planning services through the national family planning program (Title X) and allow states to expand Medicaid family planning services to women with incomes up to 200 % of the federal poverty level.

  • Ensure that private health plans offer the same level of coverage for contraception as they do for other prescription drugs and services.

  • Ensure that women who survive sexual assault receive factually accurate information about emergency contraception (EC) and access to EC upon request.

  • Support state-level comprehensive sexuality education programs that include medically accurate information about abstinence, contraception, and disease prevention.

  • Implement important public education initiatives about EC and its benefits and uses to women and medical providers.

  • Enable competitive grants to public and private entities working to establish or expand teen pregnancy prevention programs.

  • Require that all information provided about the use of contraception as part of any federally funded program is medically accurate and includes accurate information.

Monday, November 3, 2008

Working Out

As I watch the collegiate women’s crew teams glide down the Charles River with seemingly effortless strokes, I can’t help but wonder: is this a sport I might have been able to compete in when I was in college or even now? Because I attended high school and college before Title IX (the 1972 law which requires gender equity for boys and girls on every educational program that receives federal funding), I often have these Walter Mitty-like sports fantasies.

My question is answered by two fathers I talk with as I watch the sculls pass under the bridge on a crisp fall day in Cambridge. The first dad has driven from Baltimore to watch his daughter compete for MIT in a sport he loves, one she has grown up with. He tells me all I need to know as a beginner watching this sport. Later I visit with a father I know who flew from Mississippi to watch his daughter, a freshman at Harvard, participate in a sport she is only just learning. Since she wasn’t an athlete in high school, he was shocked at her interest.

Not only could I have crewed when I was younger, I admit I could still do this if I had the self-discipline to get up that early in the morning to train. I wasn’t brought up with the concept of women “working out.”

I started teaching young women about the time Title IX became law. I watched as “working out” became part of their daily regimen. They seemed healthier and more confident than my generation. They understood the art of teamwork and how to accept small defeats and learn from them.

Even though I live in a family of men who take sports seriously, I never connected the physical training of sports with pregnancy—until recently. Sarah Brown, CEO and co-founder of The National Campaign to Prevent Teen and Unintended Pregnancy speaks about the planning a woman needs to do before she becomes pregnant to assure that her body is ready.

I’ve had two planned pregnancies and upon learning I was pregnant, started a prenatal program of vitamins, pelvic tilts, and doctor visits. Nobody—including my doctor--ever framed pre-pregnancy as a physical endeavor that requires conditioning. (I do remember my husband telling me afterward that for all the sports he’d watched he had never seen a mightier physical effort than giving birth.)

Beneath the bridge beside the river, I hear grunts as the women pull their long oars through the water, arm and leg muscles taut. My thoughts return to how we convince young women that planning in general is important and planning pregnancy in particular is vital. Is it possible to use physical fitness as a way to prevent unintended pregnancy?

Could we require physical education or health class curricula to cover pre-pregnancy? Could we point out in these classes that being involved in competitive or individual sports or physically demanding activities like dance, Tae Kwon Do or Pilates, is fulfilling in and of itself, but also part of getting our bodies ready for the work of someday having children if we want them?

Through public information campaigns we were able to convince many women in my generation to quit smoking and drinking during pregnancy. Why can’t we convince young women today that being emotionally and physically ready to have a baby is akin to being physically and emotionally ready to run a marathon or play a season of basketball?

If we manage to convince a generation of young women that they need to “work out” for pregnancy then in the process maybe they’ll decide for themselves that a baby isn’t going to “work out” for them until they reach some of their other goals.