Conversations with Christie

Anchors Aweigh

2009-07-31T15:38:00.000-05:00

She trembled slightly. For a moment, I thought of what she might have been like at six, sitting on the edge of the paper-covered table in the doctor’s office waiting for the needle prick. She laughed nervously and tossed her shoulder-length mane of tight curls. Trying to distract her, I asked where she lived. I told her I’d visited the library in her home town not far from this family planning clinic. She had gone to the library every day after school, she said. She loved the librarian like family and still grieves her early death.

Since she had agreed to let me observe the nurse practitioner insert an Implanon in her upper arm, I asked how she heard about the new, long-acting, reversible contraceptive (LARC) and why she decided to get one.

She works at Wal-Mart in a minimum wage job. At 21, she lives with her grandparents, but she grew up the oldest in a family with three much younger siblings. She’s tired of not making enough money to afford to live on her own. Her family can’t afford college. She wants something more, so she enlisted in the Navy. She wants to be an electrician and she knows she can learn this skill while she serves her country and maybe later she’ll attend college. She’s leaving for basic training soon. She’s nervous about that, too. She was a good athlete in high school - softball and track - but basic training will be physically challenging, and she’ll be away from home for the first time.

The nurse practitioner arrives and in her low-key manner gathers information and explains the procedure. Is she sexually active now? (Yes) What kind of birth control is she using? (Only condoms) She knows that’s not enough. She’s heard about free Implanon from a television ad. She wouldn’t have been able to afford the $500 fee.

I explain that the non-profit I work for makes free, long-acting reversible contraceptives available to every woman in the state who wants one, that this is part of a research program to see how we can reduce the number of unintended pregnancies among women her age in Iowa first and then across the country. She likes the idea that she is part of an experiment. That’s why she agreed to let me watch.

She jiggles her arms, like she might before placing her feet in the blocks and taking her runner’s stance. The cliché a “bundle of nerves” comes to mind. But there is nothing trite about this young woman or the decision she’s making. She exudes strength and vulnerability at the same time. She is poised on the verge of womanhood. I’m witnessing her personal history. She is leaving home and everything familiar; she is making an adult decision to be responsible for her own well-being and health. She has come to the realization that her future is in her control and that having a baby right now isn’t what she wants.

As someone who has no daughters of her own, but who has taught adolescent women for years, this is a rare moment.

The nurse practitioner numbs her arm and I joke that I’m inclined to close my eyes even though I’ve driven across the state to watch this procedure which I talk about in speeches concerning the work of the Iowa Initiative. That would, of course, defeat the original purpose of my visit, but my presence in the room has become more about the decision than the device or the procedure.

She closes her eyes. I watch. In seconds, the nurse practitioner announces she’s done. We’re both surprised at how easy it is. The device, which dispenses hormones much like the birth control pill, is not visible but it feels like a small matchstick.

She laughs again, relieved. The nurse tells her she can take some Ibuprofen if it’s tender and in a few days she can remove the Band-Aid. She cautions her to continue to use a condom to protect from sexually transmitted infections; her Implanon will protect her from pregnancy for up to three years, long enough to give her a good start with the Navy.

Anchors Aweigh!

Take a Stand With Your Teenager

2009-04-15T14:03:00.003-05:00

I just read a New York Times’ article “Teenage Girls Stand by Their Man” by Jan Hoffman (March 18) about how teenaged girls are reacting to the alleged assault on pop-singer Rihanna by celebrity boyfriend Chris Brown.

I didn’t know either of these entertainers until this altercation, and that probably says something about my age and the fact that I don’t spend every waking moment with 13 and 14 years olds the way I used to. But, because I spent 25 years with eighth and ninth graders, I wasn’t surprised at the reaction of these teens to this situation.

I thought Esta Soler of the Family Violence Prevention Fund made the most salient point in the article when she said that teenagers’ opinions are fluid. “What they feel in the morning can be different from what they feel in the evening,” says Soler. That doesn’t mean we shouldn’t be uneasy about the reaction of teenagers who think the woman is at fault when she’s been assaulted. Fluidity means that teens are open to changing their minds, listening to other points of view.

In no uncertain terms, parents and influential adults must let teens know that they abhor the violence in this relationship. If we do not speak out, we are condoning the violence.

In the absence of caring adults having conversations with teenagers about relationships and civil behavior, the media will fill the gap, defining what acceptable and unacceptable behavior is.

No matter how often adolescents roll their eyes at their parents and grandparents, and no matter how many times they stomp out of the room, teen surveys tell us that it’s their parents and grandparents who most influence their attitudes. Teens want to talk with adults they trust about relationship issues, and in many cases, we’re missing an opportunity to build a long-lasting relationship with our children by not sharing with them our own experiences with the nuances of building a relationship.

When I asked college students at the University of Northern Iowa what I should tell their parents and grandparents as I travel around the state talking about unintended pregnancy, they said, “Tell them we came to college without the tools to make wise decisions.”

We can’t let media celebrities define values for our children, but we can use their celebrity as a bridge to talking with young people. If it’s unbecoming or uncivil behavior which we don’t accept or condone, as is the case with Rihanna and Chris Brown, we can say, “I think it’s wrong for one person in a relationship to hit another.” Or, “This is not the way your mother/father and I treat each other. This is no way to treat someone you love.” Or, “How do you think Rihanna should have handled the situation? Do you think she should press charges?”

Then, we need to be quiet and listen. Teenagers have opinions, even if they’re fluid, and their opinions are important even though they may not match ours. They need to try out their opinions in a comfort zone, but it’s our job to let them know where we stand.

We have another choice: to partner with the media to broaden the conversation with teens about relationships including sexually intimate relationships. The National Campaign to Prevent Teen and Unplanned Pregnancy is taking the lead in this by highlighting various popular TV shows on their website that touch on issues of unintended pregnancy and intimate relationships. For instance, they provide discussion topics for watching episodes of The Secret Life of the American Teenager. And, you can link to a relevant episode of The Family Guy. Check out their media section.

Whether it’s dating violence, unintended pregnancy, or how to communicate with a roommate, it’s important for parents to look for opportunities to have conversations with teenagers, always respecting their opinions and recognizing their fluidity. And, if the media and its celebrities provide us with that opportunity, whether it’s Bristol Palin speaking out or Rihanna choosing not to, let’s use it to our children’s advantage.

Health(Car)e Talk

2009-03-27T16:03:00.002-05:00

I didn’t get called on at the regional White House Forum on Health Reform in Des Moines this week, and it’s my own fault for not waving my hand more aggressively. I stewed about it for awhile, because no one mentioned women’s reproductive health or pregnancy prevention, and that’s what I was there to talk about.

The next day on NPR I heard that no insurance representatives were called on either.
This was not a slight for them or me; it’s just that there were over 500 people in the room and most of them wanted to talk.

The more I thought about Nancy Ann DeParles’s parting words, the more I realized that my role might have been to listen. As the White House Healthcare Reform Czar, DeParle recapped what she thought she’d heard. She suggested that in other attempts to reform the health care system in this country, stakeholders came to the table with a perfect plan, and when their perfect plan wasn’t adopted, they chose to stick with the status quo rather than compromise. What she thinks she’s hearing now is that people are willing to listen and willing to create a not-so-perfect plan, then work to make it better.

In the course of the forum, I re-crafted what I wanted to say if I had the chance. Then a guy stood up and said that he’d heard a lot of representatives of various interests talk about how they wanted to be “at the table” when decisions are made, but that wasn’t why he was there. He wanted to suggest a solution. I decided to listen more carefully.

Yes, I want pregnancy prevention to be part of the conversation, but I was impressed by the eloquence of the head of the nursing association. I was moved by the president of AFSCME who said home health care workers who toil all day helping our most vulnerable elderly citizens can’t afford health insurance. By listening I better understood the enormity of issues facing us and the necessity of compromise.

I know the squeaky wheel gets the grease, but I know also that a car is the sum of its parts, and any vital part that malfunctions means the car isn’t going anywhere anytime soon. So the forum was a valuable opportunity to stand around the car, expounding on its imperfections, peccadilloes, flawed design and how this part or that could make it better. But, in the end, a team of mechanics is going to have to get under the car and get dirty fixing it.

After we’ve had our say, we need to listen to the dialogue between Congress and the Administration and if the vehicle runs when they’re finished, we need to test drive it even if it sputters a little. We can always take it back for a tune up.

Mary’s Center – Community, Health and More

2009-03-18T09:10:00.002-05:00

A fifteen minute walk from trendy DuPont Circle in Washington DC takes me to Mary’s Center on Ontario Street. I have come to visit the family computer literacy program honored with the Verizon Tech Savvy Award, which I created as Iowa’s first lady. I wanted to identify best practices among programs that teach technology skills to parents and children together.

What I didn’t expect was a neighborhood services potluck: a health clinic, a Reach Out and Read site, a WIC clinic, mental health and domestic violence counseling, and founder, nurse, Maria Gomez, who has been serving her neighborhood for 20 years.

Students, mostly women, pack small classrooms encircled with computers. In level one, students struggle to say their names in English. In level three, students discuss in English the values they want to teach their children. The hall is a parking lot for strollers. The babies are cared for in the daycare down the hall.

The health clinic hums, no chair empty. Men, women and children wait to see a doctor. Originally a maternal health clinic, Mary’s Center has expanded its mission to include men and has been designated a federally-funded community health center.

Founder and CEO Maria Gomez recounts the story of the day 20 years ago when she asked gang members to vacate the corner so their mothers and sisters could come safely to the clinic for treatment. They were gone the next day and never returned.

Upscale homes and businesses pepper the area now, encroaching on a predominantly Latino neighborhood. Maria cobbles together enough money to keep the clinic and literacy programs alive, but her success in serving the needs of the neighborhood means space has become an issue.

She is proud that First Lady Michelle Obama visited the daycare recently. She knows just how she plans to use increased federal funding next year to expand services. She has the use of a corridor of rooms in a nearby elementary school and she’s opened a site in a Latino neighborhood in nearby Maryland.

Coincidentally, many parts of my life come together in Mary’s Center. The Tech Savvy Award brings me here, but I also serve on the national board of Reach Out and Read, a non-profit that enlists the help of pediatricians to use books as diagnostic tools and to convince parents to read aloud to their children. As Secretary of Agriculture, my husband oversees the nation’s WIC (women, infants and children) food assistance program, which is currently encouraging women to buy fresh fruits and vegetables.

I serve as executive director of the Iowa Initiative, a non-profit focused on reducing the number of unintended pregnancies among women ages 18-30. Mary’s Center also counsels women about family planning issues and dispenses birth control.

Part of my job involves talking to civic organizations about working together in communities to improve women’s reproductive health. I spend a lot of time with decision-leaders and policy makers who fund Title X family planning services or provide resources at the state level. I learn from people who gather statistics and write about issues like providing access to free, long-acting reversible contraceptives (LARC).

But sometimes, it’s helpful just to see how it all works for people in the course of their everyday lives: How do they fit a pap smear, a well-baby check up and an English class into the same Mary’s Center visit? How does it feel to introduce themselves in a new language to a visiting dignitary? It’s also rejuvenating to listen to the story of one ordinary woman who decided to make a difference in her neighborhood and succeeded.

Out-of-Wedlock?

2009-02-26T14:01:00.001-06:00

Several weeks ago, a news flurry about out-of-wedlock births caused the Iowa media to contact my office about a reported “uptick.” I was so distracted by the reference to out-of-wedlock births that I had a difficult time focusing on the conclusions journalists were trying to draw from the numbers.

First, the words themselves are out-of-date and irrelevant. In a world where women are deciding to become mothers outside of marriage, where eggs can be fertilized in a petri dish, where married and unmarried women use artificial insemination, where women serve as surrogate parents for childless couples, where gay couples who legally can’t marry use technology to conceive or choose to adopt children, I question using archaic language so out-of-sync with reality.

As a journalist and English teacher, I teach that words and labels matter, that the connotations of words matter. As someone married to an “illegitimate child,” a man born “out-of-wedlock,” I am especially sensitive to this particular designation.

A look at the 2007 Vital Statistics of Iowa Report, shows out-of-wedlock births to be one of thousands of categories including “live births to mothers ages15-17 ranked by county” and “average age of marriage l997-2007.” Any number having to do with every kind of death, birth, marriage and divorce is listed there.

One reporter who called our office said he was referring to statistics released by the Iowa Department of Public Health, so it’s clear journalists rely on these numbers and the language that accompanies them. I’ve heard that policymakers also rely on these statistics to make decisions and craft legislation.

Apart from the argument that the word is irrelevant, shouldn’t we re-examine why it matters today that a child is born “out-of-wedlock?” If the language doesn’t reflect the changes in our society, is it possible the numbers don’t either? I’m interested in learning how policy-makers or other decision-makers use these numbers.

Is it possible that if we change the language of categorizing that we’ll change the way decision-leaders use and interpret the numbers?

Let me know how you feel about the use of the words “out-of-wedlock” in a society where we commonly refer to couples in a “committed relationship.” I’m also interested in knowing how “out-of-wedlock” statistics are used by policy-makers to make decisions and how these decisions might affect peoples’ lives positively or negatively.

Pay Equity for Women

2009-02-02T16:20:00.004-06:00

On January 22nd, I sat in the gallery of the U.S. Senate watching a debate on the Lilly Ledbetter bill which involves pay equity for women. Senator Barbara Mikulski of Maryland squared off against Senator Kay Bailey Hutchinson of Texas. I was surprised to find not only the visitors and press galleries nearly empty but the Senate chamber as well.

Senator Hutchinson was trying to pass an amendment because she thought, as written, the bill would hurt small businesses. If companies don’t want a bad reputation, they shouldn’t discriminate, argued Senator Mikulski. Her argument was echoed by my senator, Tom Harkin of Iowa, an original co-sponsor of the bill. He said, “This is a women’s issue, it is a fairness issue, it is a family issue. And it is time for Congress to pass this law to right this gross injustice.” After debate, senators voted to defeat Hutchinson’s amendment. When it came time to vote on the entire bill, in the final vote that evening, all the women senators voted in favor and it passed. Last week President Obama signed the bill, his first.

The signing of the bill will overturn a Supreme Court case that ruled against Lilly Ledbetter’s claim of discrimination. After working as a supervisor with Goodyear Tire for 19 years she discovered that male supervisors had been paid a higher salary. Not only had she made less over those many years but her lower salary meant she now received less in retirement. She took her battle to the Supreme Court and lost. But even that didn’t stop her. She invested the next 10 years of her life in the struggle to guarantee women equal pay.

When I left the Senate to walk to the Metro, I got caught up in a group of pro-life protesters on a street corner, there to express their opinions on a day that marked the 36th anniversary of Roe v. Wade. It struck me that these two concurrent events speak to the power one woman can have to create change.

One woman took a stand and led the struggle to guarantee equal pay for women. Another woman Norma McCorvey, known to most of us as “Jane Roe” stood up for her right to reproductive choice. These women teach us all that one woman really can make a difference in the lives of many, whether she’s a teacher, a nurse practitioner, a legislator, a grandmother or a community activist.

It also occurs to me that the issues these two women fought for are actually very much related to one another. A woman who is compensated fairly for the work she does is a woman who pays more taxes, a woman who can plan her pregnancies, a woman who can support herself in retirement.

Lilly Ledbetter and the people who helped her along the way, including the elected officials who supported her cause last week in Congress, are an inspiration.

To see President Obama sign the Lilly Ledbetter Fair Pay Act of 2009 or to learn more click HERE.

Diversity Award

2009-01-09T15:30:00.003-06:00

With money from the Family Planning Council of Iowa and the Iowa Initiative, Planned Parenthood of Southeast Iowa hired two bilingual staff for outreach to the growing Hispanic communities and the investment is already paying off. Listening to
Alejandra Rebolledo, Hispanic Outreach Coordinator, talk about her work, it’s not surprising that she helped PPSI win the Central Region Diversity Award, which means an extra $1,000 for their education department.

Her enthusiasm is contagious: Hispanic women want to know more about birth control and how to prevent getting an STD or HIV; they are interested in learning how to communicate with other family members about sexuality.

Alejandra teaches a six-week series of women’s reproductive healthcare classes in Spanish. The first week they talk about anatomy, followed by information about pap smears and mammograms. Week three is about birth control including LARC (long-acting reversible contraceptives). In weeks four and five, she teaches about sexually transmitted diseases including HIV. The last week they talk about communicating with children about sexuality and talking to partners about condom use.

“If you don’t have good communication with mom and dad, then it’s difficult to have communication with children,” says Alejandra. For some, their religious beliefs are a barrier to getting information. Alejandra says she always tells women that she respects their point of view but that her information is research-based and medically accurate. She finds her role as a teacher really rewarding. Some of the ladies she teaches have said, “God bless you and thanks for sharing.”

2008-12-19T13:05:00.000-06:00

Over a bowl of chili at lunch, I scanned the Des Moines Register. An article about a girls' high school bowling championship caught my eye. Bowling is now a sanctioned sport for women in 80 Iowa high schools, the 10th such sport for women. When I started teaching in Iowa in l975, track was the only women’s sport and then only because Title IX forced high schools to offer girls athletic opportunities.

That same year, Tom answered a knock at our apartment door one night and there stood several high school boys holding a huge trophy. Schools didn’t sanction bowling at that time so these kids asked Tom, who was Booster Club president, to make a personal donation so they could attend the state bowling league championship. He was their sole sponsor, so their arrival to present him with the state bowling trophy was a surprise.

Bowling is good exercise, it’s fun and helps people understand teamwork and the ups and downs of competition, which is a part of our everyday lives as adults.

In the article, Lincoln High School girls spoke about the fun of competing in the state championship and their pride in the recognition they’ve received. These women are learning a life-time sport, something they can do with a date, a spouse or life-partner; something they can do with their children someday, or a great way to enjoy a night out with friends.

The assistant director of the Girls Athletic Union says that this sport reaches 40% of students who are not involved in their schools in any other way. That’s the best part. Team sports are one more alternative to premature sexual activity, one more esteem-building activity. We’ve come a long way.

Opportunities

2008-12-17T16:32:00.005-06:00

Diana Rodrigez grins at her dad who sits next to her when a sentence she has cut from another document magically appears on the computer monitor before her. The Computers for Youth teacher switches between English and Spanish to accommodate the diverse parent-child population gathered at Leonardo da Vinci Middle School in Corona, Queens, New York on a Saturday morning for a first lesson in technology.

Another dad in the front of the room yawns. He’s just gotten off work and would normally be home asleep, but he has to attend the class in order for his son to take home the free, refurbished computer offered to families by this program that puts parents together with their children to learn some basic word processing skills.

The director of the program, Kavita Gilchrist, says that many of the 700 6th graders at this school will attend one of the Saturday morning classes with a parent so they can access the computers, even though the program can no longer offer Internet access.

In front of Diana a boy can’t get the hang of the double-click. He tries again and again, his third finger awkwardly getting in the way. I am reminded not to assume that all 6th graders in this country have mastered the double-click or the right-click.

I have to listen carefully to understand a teacher talking in another room to a group of Spanish-speaking families about the importance of parents monitoring what children are accessing on the computers. In Spanish, he explains My Space and Facebook and tells parents that these 6th graders are too young to have an account.

In most cases these families will be unable to afford to hook up to the Internet, but the software downloaded already into the computers will allow children and parents to access language skills and math skills that already are boosting test scores for the children in this low-income neighborhood, according to Principal Lisa.

What does this have to do with reducing unintended pregnancy among women 18-30? When you give girls opportunity, you nurture dreams of extended education and job opportunities. You offer them choices about when, how often and even if to have children.

It’s the joy of opportunity I saw on the face of Diana Rodrigez, and I saw that joy mirrored in the face of her father, who had made a sacrifice to be there and make sure his daughter had that opportunity.

Gloria

2008-12-12T09:25:00.003-06:00

Fifty-eight years ago, a 23-year old women gave up her job as a secretary and entered a home for unwed mothers in Pittsburgh. On December 13, she gave birth to my husband, then left him behind in the orphanage in care of the Catholic nuns. Four months later he was adopted by Bud and Dolly Vilsack. The way they described it to him, they chose him as they might a holiday turkey—the plumpest baby—and took him home to join his older sister Alice.

When I met my husband as a college freshman 40 years ago, he told me he was adopted. Maybe because we were 17 when we met, we always assumed that his birth mother was our age when she discovered she was pregnant in l950. Sometimes we imagined where she might be and assumed she had born other children, but Tom was never curious enough to go looking for her. He was satisfied with his Pittsburgh family. Despite his father’s financial woes and his mother’s alcoholism, he always knew he was loved. His dad died in our senior year of college and his mother died just before our first son was born in l977. His sister died suddenly a few years later. None of them lived long enough to know him as the Governor of Iowa or as a candidate for president.

It was during a campaign announcement tour that we stopped in Pittsburgh in November 2006. A few weeks after his name and picture appeared on the news he received a letter from the nuns who had cared for him before his adoption. They said they had information he might want about the circumstances of his birth. They couldn’t reveal the name of his birth mother because she had never given them permission to do that, but they would give him any other information they had.

His political advisors suggested he could find out himself or read it in the newspaper one morning. The letter arrived near his birthday. His birth mother took the assumed name Gloria when she entered the home for unwed mothers. She was 23 and a secretary. She was the oldest of 5 children in a Catholic family with an Irish surname. His mother didn’t leave the home right away after his birth. Considering our assumptions, this news was shocking.

Did she think about keeping him, Tom wondered? Marriage must not have been an option. Could her family afford to help support them? Did they consider their oldest daughter a bad influence on the other children? Could she afford to raise him on her own? We’ll never know. If she’s still living she is now 82 years old.

Coincidentally, finding Gloria coincided with a new job for me as executive director of The Iowa Initiative to Reduce Unintended Pregnancies, an organization dedicated to creating a national model for how states and the federal government can invest in pregnancy prevention among adult women 18-30. When I held a press conference in January to announce the goals of the organization and my association with it, I mentioned Gloria’s story, and said that she would motivate me every day as I travel the state educating people about the high rate of unintended pregnancy among adult women, which most voters and decision makers know little about.

Rather flippantly, a reporter said to me afterward, “Well, your husband turned out all right, didn’t he?” “Yes,” I said, “he did; but how did she turn out?” It was l950. She had to quit her job and enter a home for unwed mothers. She had to give up her financial security. Did she further her education? Did she marry; have other children? Is she surrounded by a covey of grandchildren who love her? How was her life changed by the decisions she made? We won’t know.

But I do believe, knowing my husband and what he’s accomplished, that Gloria must have been an intelligent woman with a great deal of potential. I do believe that all of us have the opportunity to give women a chance to reach their potential by assuring that they have the information they need and the access they need to the newest birth control methods, so they can control their own fertility and plan their futures.

This holiday season, I honor all the Glorias whose lives were changed by their unintended pregnancies, and I honor the difficult choices they made.

What Do You Talk About With Your Hairstylist?

2008-12-02T15:40:00.006-06:00

My hairdresser says that when she was in school to become a stylist she was taught that clients are more apt to share personal information with the person who cuts, colors and styles their hair, because people respond to the human touch. Because barbers and hairstylists actually touch us, we tend to trust that person and reveal more about ourselves. Asking hairstylists and barbers to share healthcare information didn't start with birth control, however. Other studies have proved that barbers and hairstylists have helped to spread info about diabetes and cardio-vascular disease.

Our researcher Mary Losch at the University of Northern Iowa's Center for Social and Behavioral Research will be keeping data about this project so we can determine if using hairstylists to inform l8-30 year olds about long-acting reversible contraceptives (LARC) works. Our website provides a comprehensive list of all contraceptives so that people who know little about the new technology will have an overveiw of each method.

“…To go far, go together.”

2008-11-25T08:47:00.001-06:00

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!

Please, Have a Conversation...

2008-11-21T13:15:00.002-06:00

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.

U.S. 29th in Infant Mortality?

2008-11-12T15:14:00.002-06:00

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

2008-11-12T13:24:00.004-06:00

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

2008-11-12T13:13:00.002-06:00

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.

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

2008-11-05T12:42:00.008-06:00

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.

Working Out

2008-11-03T14:12:00.004-06:00

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.

2008-10-20T16:00:00.001-05:00

I was surprised to learn the term pre-conception care from Sarah Brown, co-founder of the National Campaign. When I was 26 and wanting to get pregnant with my first child, it never occurred to me to prepare myself physically like an athlete getting ready to run a marathon. I knew I needed to get prenatal care after I got pregnant: take a few vitamins and get monthly checkups. But thinking about whether I was healthy enough to bear a healthy child? It never occurred to me. I seemed healthy. I didn’t even have a doctor when I got married. The clinic where I got my birth control pills was my only healthcare. Sarah is right. Women who lack immunizations, have issues of alcoholism, drugs, obesity, or who have chronic diseases like diabetes, might have trouble birthing a healthy baby or might endanger her own health without pre-conception care. Having a health issue doesn’t mean a woman can’t give birth to a healthy baby, but it means women must be taught to plan and prepare for pregnancy; it shouldn’t take her by surprise.

We Plan What We're Having For Dinner, But Not Pregnancy?

2008-10-20T10:43:00.007-05:00

We recently had Sarah Brown, CEO of the National Campaign to Prevent Teenage Pregnancy and Unplanned Pregnancy, here in Des Moines to continue our conversation about reducing the number of unintended pregnancies among adult women in Iowa. She visited with family planning service providers from around the state, legislators, journalists and professionals connected with this issue.

Sarah says Americans plan everything: household budgets, vacations, what we’re having for dinner. She quoted a New York Times article that mentions the increase in wedding planners in the U.S. Yet we don’t plan pregnancies. Even though giving birth and having children is one of our most important acts, with a permanent impact on our lives, we don’t discuss the decision with partners or plan individually (especially 20 year-olds). Too many sexually active people don’t think about the consequences an unintended pregnancy might have on income, education, time or energy.

Sarah encourages parents and caring adults to include talking about the planning pregnancy along with the other issues we encourage young people to consider as they reach adulthood. This includes talking with family planning professionals about choosing a birth control method that meets each couple’s needs.

Reading on the beach...

2008-10-08T09:38:00.002-05:00

The beach is the perfect place to read The Lolita Effect. Toddlers are dressed in bikinis and tweens are promenading in bathing suits that leave little to the imagination—this on a beach that is advertised as the most family-oriented beach in the U.S. Two little girls practice a move that involves jutting out a hip and several pelvic thrusts. This is my backdrop for a book authored by Gigi Durham, a journalism professor at the University of Iowa. She contends that the media in cahoots with big business is creating a health crisis for the world’s young women that affects teenagers in the suburbs of Minneapolis, 11 year-old prostitutes in Bangladesh and college co-eds worldwide. She stresses that each young woman has a right to make decisions about her own sexuality, to learn to define what is best for her as she grows older and matures.

Durham says that young women today are learning how to be sexual from the media, which is trying to sell products without regard for the best interests of young women. She says if parents and health educators don’t talk to children about sexuality that the ads, movies, musicians, and the Internet will fill the void. I like this book for its practical approach. Durham tells parents, grandparents, teachers and other caring adults what they can do to generate conversation with young men and women to help them learn to be critical consumers of the media. It’s also a blueprint for how adults can initiate a public conversation with decision-makers at the local level.

Narrowing My Focus

2008-09-08T11:48:00.006-05:00

For ten years I’ve been up close and personal with big-picture issues: renewable fuels, peace in the Middle East, No Child Left Behind, health care for children. Bigger than life people: Madeline Albright, Jon Bon Jovi, Hillary Clinton, Lance Armstrong. Big changes for Iowa: transforming the economy with wind energy, universal preschool, Vision Iowa recreation and tourism grants, economic opportunities in India and China. Big events: the Kentucky Derby, national political conventions, the Super Bowl, White House galas. Big restaurants in every major city with big civic and political donors. Big disasters: Iowa tornadoes and flooding, terrorist attacks, the aftermath of Katrina. Big decisions: endorsing John Kerry, vice-presidential vetting, my husband’s decision to run for President. Treasured memories all.

My tenure as Iowa’s First Lady is behind me, and I have charted a new course for the next part of my life. Tom and I have new jobs in Des Moines, which means we can’t return to the small-town life we led for twenty years while we raised our children, while Tom worked as a small town lawyer and mayor, and I worked as a teacher and reporter. I could not be more proud of the work we did as parents, community leaders, as policy leaders for our state and as representatives of our Party on the national stage.

For now, however, I’ve turned my lens from wide-angle to close-up and I’m focusing more deeply on one issue, an issue born of my life-long commitment to teen and young adult women and most recently my work to elect a woman president, a politician who provided a role model for women world-wide and who had the experience to tackle health policy issues generally and women’s health issues specifically.

At the Iowa Initiative to Reduce Unintended Pregnancies I am part of a collaboration of people committed to offering quality reproductive health services to every Iowa woman. We are working together to build a national model to reduce the number of unintended pregnancies among adult women. This will require networking, educating, finding a common message, providing women access to long-acting reversible contraceptives, researching, and reporting our discoveries. As I travel around the state and the country encouraging community conversations about issues connected to our mission, I’ll use this blog as a place to reflect. Putting this larger issue into perspective requires that I also turn my attention to small-world experiences in my family, my neighborhood, and my community.

So expect to find here the real-life stories of community conversations and unintended pregnancy I collect as I travel the state, the global perspective of a trip to Africa to visit family planning clinics and discuss mother-to-child transmission of HIV-AIDS, as well as reflections on our decision to spay our six year-old Labrador, Rosie.