Anchors Aweigh

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

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

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

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?

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

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

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.”