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.