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

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

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?

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.”

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...

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?

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.

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.

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.

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?

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...

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

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.