Sex Ed Year Round

Nora Dye

Nora's cross-country bicycle trip takes her through Philadelphia, where she meets with all sorts of people working to facilitate women's control over their bodies and their lives.

At long last, I bring you the full and unexpurgated recounting of my time in Philadelphia. Whee! Wednesday and Thursday were chock full of meetings with all sorts of people working to facilitate women's control over their bodies and their lives.

I started the day off at Choice, an organization dedicated to increasing awareness of and access to reproductive health care, especially among under-served populations who traditionally experience barriers to care. At Choice, I met Jackie, who coordinates their 4(!) hotlines, and walked through the bustling hotline reception room on our way to her office. I'm always interested in the posters and paraphernalia that people choose for their offices. There are a few things that are nearly ubiquitous—the "Just do it" condom stickers, various incarnations of the Rosie the Riveter poster, a rainbow of buttons.

I was particularly interested to visit Choice because in San Francisco I was a Board Member at ACCESS, an organization that does similar work in California. Pennsylvania, it turns out, has some of the most restrictive laws in the area—there is a parental consent law for abortion that is enforced, and state Medicaid funding for abortions is restricted to women who are pregnant as a result of rape of incest or for whom carrying the pregnancy to term would pose a "life risk", defined as threatening her mental or physical health. (In California, for instance, women who are faced with an unplanned pregnancy who aren't able to afford an abortion can get emergency Medicaid to cover the cost of the procedure, although the number of providers who accept Medicaid is decreasing).

Incidentally, Pennsylvania follows federal guidelines which were enacted by the Hyde Amendment in 1977. The Hyde amendment bans state use of federal Medicaid dollars to pay for abortions unless the pregnancy is the result of rape or incest, or the abortion is "necessary to save the life of the woman." States can use their own funds to cover other medically necessary abortions—usually defined by states as those to protect the physical or mental health of the woman—for Medicaid recipients. These restrictions leave thousands of low-income women vulnerable to delayed care, financial burden, and unsafe, illegal abortion by requiring them to come up with the money for their procedures.

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Choice advocates for women seeking reproductive health care on a number of levels, including with health care providers. It turns out that the biggest barrier women face to getting Medicaid funding for procedures is the providers themselves. In order to qualify for the funding, doctors have to sign a form stating that a woman meets one of the three requirements set forth by the Hyde Amendment, and many doctors, even at reproductive health clinics, are reluctant to sign the forms. Many women get their initial pregnancy test from their general practice doctor, who would be the logical person to sign form enabling them to get Medicaid funding. Those doctors give a variety of reasons for their reluctance to sign the waiver, from religious objections to abortion to fears of scrutiny from medical boards. Jackie related that one doctor told a woman "We don't deal with women's issues." Can you imagine being faced with an unplanned pregnancy and having a doctor tell you that?

I asked Jackie how they incorporated advocacy into the work they did—certainly a huge part of their mission is dedicated to helping women advocate for themselves personally, but I was curious if they positioned that work in a political context, if they talked to the women they were helping about the need for political advocacy to remove barriers to accessing care. She raised what has been a particularly thorny problem—that many women who are having trouble accessing health care are also dealing with numerous other issues in their lives, and writing a letter to their member of Congress isn't a high priority given everything else they've got going on. Choice does make a concerted effort to educate women about their role within the medical system and what rights they have within that system.

During this conversation Jackie said "you know, some people don't believe in access to some kinds of medical care", which really struck me, not because it's not obvious from all the laws and restrictions they've passed, but because I'd never heard it put in quite that way before. I mean, I get not agreeing with some of the choices people make, but to not BELIEVE in their right to access care is a pretty horrific idea, if you ask me.

My next stop was Planned Parenthood of Southeastern Pennsylvania, a formidable affiliate best known for their role as the plaintiff in Planned Parenthood of Southeastern Pennsylvania v. Casey, in which the Supreme Court ruled that states could impose restrictions on access to abortion like parental consent laws and mandatory waiting periods as long as they don't pose an "undue burden" on a women's ability to access abortion. I met with Karen Fitchette-Gordon, the Vice President for Education and Professional Development.

Karen runs a truly extraordinary Education department—they have nearly a dozen different programs that include Youth First, a year round program in Philadelphia schools that serves over 1700 students each year in sixth and eighth grade. Yup, you heard that right. Year round. Most sex education happens, at best, for a day or two once or twice during middle and high school. These students get one period of sex education a week for their entire sixth and eighth grade years. Oh-la-la. I have long despaired at the brevity of sex education classes, knowing how long it takes to really have conversations about safer sex and positive sexuality, so I was delighted to learn that there were places where the importance of maintaining a conversation about sexuality with youth was acknowledged and encouraged.

And guess what? The students who participate in Youth First in sixth grade are less likely to be sexually active in eighth grade and more likely to have safe sex if they are sexually active. Well, doesn't that just beat all. I'm reminded of the Waxman report, a Congressional inquiry led by Congressman Henry Waxman which found that students who take virginity pledges are less likely to use contraception when they have sex (which 88% of them do, before marriage, according to Columbia University researchers), and are less likely to seek STD testing despite comparable infection rates.

Republished with permission. Read more about Nora's journey at Wanderlust with Rhonda.

News Health Systems

Complaint: Citing Catholic Rules, Doctor Turns Away Bleeding Woman With Dislodged IUD

Amy Littlefield

“It felt heartbreaking,” said Melanie Jones. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

Melanie Jones arrived for her doctor’s appointment bleeding and in pain. Jones, 28, who lives in the Chicago area, had slipped in her bathroom, and suspected the fall had dislodged her copper intrauterine device (IUD).

Her doctor confirmed the IUD was dislodged and had to be removed. But the doctor said she would be unable to remove the IUD, citing Catholic restrictions followed by Mercy Hospital and Medical Center and providers within its system.

“I think my first feeling was shock,” Jones told Rewire in an interview. “I thought that eventually they were going to recognize that my health was the top priority.”

The doctor left Jones to confer with colleagues, before returning to confirm that her “hands [were] tied,” according to two complaints filed by the ACLU of Illinois. Not only could she not help her, the doctor said, but no one in Jones’ health insurance network could remove the IUD, because all of them followed similar restrictions. Mercy, like many Catholic providers, follows directives issued by the U.S. Conference of Catholic Bishops that restrict access to an array of services, including abortion care, tubal ligations, and contraception.

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Some Catholic providers may get around the rules by purporting to prescribe hormonal contraception for acne or heavy periods, rather than for birth control, but in the case of copper IUDs, there is no such pretext available.

“She told Ms. Jones that that process [of switching networks] would take her a month, and that she should feel fortunate because sometimes switching networks takes up to six months or even a year,” the ACLU of Illinois wrote in a pair of complaints filed in late June.

Jones hadn’t even realized her health-care network was Catholic.

Mercy has about nine off-site locations in the Chicago area, including the Dearborn Station office Jones visited, said Eric Rhodes, senior vice president of administrative and professional services. It is part of Trinity Health, one of the largest Catholic health systems in the country.

The ACLU and ACLU of Michigan sued Trinity last year for its “repeated and systematic failure to provide women suffering pregnancy complications with appropriate emergency abortions as required by federal law.” The lawsuit was dismissed but the ACLU has asked for reconsideration.

In a written statement to Rewire, Mercy said, “Generally, our protocol in caring for a woman with a dislodged or troublesome IUD is to offer to remove it.”

Rhodes said Mercy was reviewing its education process on Catholic directives for physicians and residents.

“That act [of removing an IUD] in itself does not violate the directives,” Marty Folan, Mercy’s director of mission integration, told Rewire.

The number of acute care hospitals that are Catholic owned or affiliated has grown by 22 percent over the past 15 years, according to MergerWatch, with one in every six acute care hospital beds now in a Catholic owned or affiliated facility. Women in such hospitals have been turned away while miscarrying and denied tubal ligations.

“We think that people should be aware that they may face limitations on the kind of care they can receive when they go to the doctor based on religious restrictions,” said Lorie Chaiten, director of the women’s and reproductive rights project of the ACLU of Illinois, in a phone interview with Rewire. “It’s really important that the public understand that this is going on and it is going on in a widespread fashion so that people can take whatever steps they need to do to protect themselves.”

Jones left her doctor’s office, still in pain and bleeding. Her options were limited. She couldn’t afford a $1,000 trip to the emergency room, and an urgent care facility was out of the question since her Blue Cross Blue Shield of Illinois insurance policy would only cover treatment within her network—and she had just been told that her entire network followed Catholic restrictions.

Jones, on the advice of a friend, contacted the ACLU of Illinois. Attorneys there advised Jones to call her insurance company and demand they expedite her network change. After five hours of phone calls, Jones was able to see a doctor who removed her IUD, five days after her initial appointment and almost two weeks after she fell in the bathroom.

Before the IUD was removed, Jones suffered from cramps she compared to those she felt after the IUD was first placed, severe enough that she medicated herself to cope with the pain.

She experienced another feeling after being turned away: stigma.

“It felt heartbreaking,” Jones told Rewire. “It felt like they were telling me that I had done something wrong, that I had made a mistake and therefore they were not going to help me; that they stigmatized me, saying that I was doing something wrong, when I’m not doing anything wrong. I’m doing something that’s well within my legal rights.”

The ACLU of Illinois has filed two complaints in Jones’ case: one before the Illinois Department of Human Rights and another with the U.S. Department of Health and Human Services Office for Civil Rights under the anti-discrimination provision of the Affordable Care Act. Chaiten said it’s clear Jones was discriminated against because of her gender.

“We don’t know what Mercy’s policies are, but I would find it hard to believe that if there were a man who was suffering complications from a vasectomy and came to the emergency room, that they would turn him away,” Chaiten said. “This the equivalent of that, right, this is a woman who had an IUD, and because they couldn’t pretend the purpose of the IUD was something other than pregnancy prevention, they told her, ‘We can’t help you.’”

News Human Rights

What’s Driving Women’s Skyrocketing Incarceration Rates?

Michelle D. Anderson

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

Local court and law enforcement systems in small counties throughout the United States are increasingly using jails to warehouse underserved Black and Latina women.

The Vera Institute of Justice, a national policy and research organization, and the John D. and Catherine T. MacArthur Foundation’s Safety and Justice Challenge initiative, released a study last week showing that the number of women in jails based in communities with 250,000 residents or fewer in 2014 had grown 31-fold since 1970, when most county jails lacked a single woman resident.

By comparison, the number of women in jails nationwide had jumped 14-fold since 1970. Historically, jails were designed to hold people not yet convicted of a crime or people serving terms of one year or less, but they are increasingly housing poor women who can’t afford bail.

Eighty-two percent of the women in jails nationwide find themselves there for nonviolent offenses, including property, drug, and public order offenses.

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Overlooked: Women and Jails in an Era of Reform,” calls attention to jail incarceration rates for women in small counties, where rates increased from 79 per 100,000 women to 140 per 100,000 women, compared to large counties, where rates dropped from 76 to 71 per 100,000 women.

The near 50-page report further highlights that families of color, who are already disproportionately affected by economic injustice, poor access to health care, and lack of access to affordable housing, were most negatively affected by the epidemic.

An overwhelming percentage of women in jail, the study showed, were more likely to be survivors of violence and trauma, and have alarming rates of mental illness and substance use problems.

“Overlooked” concluded that jails should be used a last resort to manage women deemed dangerous to others or considered a flight risk.

Elizabeth Swavola, a co-author of “Overlooked” and a senior program associate at the Vera Institute, told Rewire that smaller regions tend to lack resources to address underlying societal factors that often lead women into the jail system.

County officials often draft budgets mainly dedicated to running local jails and law enforcement and can’t or don’t allocate funds for behavioral, employment, and educational programs that could strengthen underserved women and their families.

“Smaller counties become dependent on the jail to deal with the issues,” Swavola said, adding that current trends among women deserves far more inquiry than it has received.

Fred Patrick, director of the Center on Sentencing and Corrections at the Vera Institute, said in “Overlooked” that the study underscored the need for more data that could contribute to “evidence-based analysis and policymaking.”

“Overlooked” relies on several studies and reports, including a previous Vera Institute study on jail misuse, FBI statistics, and Rewire’s investigation on incarcerated women, which examined addiction, parental rights, and reproductive issues.

“Overlooked” authors highlight the “unique” challenges and disadvantages women face in jails.

Women-specific issues include strained access to menstrual hygiene products, abortion care, and contraceptive care, postpartum separation, and shackling, which can harm the pregnant person and fetus by applying “dangerous levels of pressure, and restriction of circulation and fetal movement.”

And while women are more likely to fare better in pre-trail proceedings and receive low bail amounts, the study authors said they are more likely to leave the jail system in worse condition because they are more economically disadvantaged.

The report noted that 60 percent of women housed in jails lacked full-time employment prior to their arrest compared to 40 percent of men. Nearly half of all single Black and Latina women have zero or negative net wealth, “Overlooked” authors said.

This means that costs associated with their arrest and release—such as nonrefundable fees charged by bail bond companies and electronic monitoring fees incurred by women released on pretrial supervision—coupled with cash bail, can devastate women and their families, trapping them in jail or even leading them back to correctional institutions following their release.

For example, the authors noted that 36 percent of women detained in a pretrial unit in Massachusetts in 2012 were there because they could not afford bail amounts of less than $500.

The “Overlooked” report highlighted that women in jails are more likely to be mothers, usually leading single-parent households and ultimately facing serious threats to their parental rights.

“That stress affects the entire family and community,” Swavola said.

Citing a Corrections Today study focused on Cook County, Illinois, the authors said incarcerated women with children in foster care were less likely to be reunited with their children than non-incarcerated women with children in foster care.

The sexual abuse and mental health issues faced by women in jails often contribute to further trauma, the authors noted, because women are subjected to body searches and supervision from male prison employees.

“Their experience hurts their prospects of recovering from that,” Swavola said.

And the way survivors might respond to perceived sexual threats—by fighting or attempting to escape—can lead to punishment, especially when jail leaders cannot detect or properly respond to trauma, Swavola and her peers said.

The authors recommend jurisdictions develop gender-responsive policies and other solutions that can help keep women out of jails.

In New York City, police take people arrested for certain non-felony offenses to a precinct, where they receive a desk appearance ticket, or DAT, along with instructions “to appear in court at a later date rather than remaining in custody.”

Andrea James, founder of Families for Justice As Healing and a leader within the National Council For Incarcerated and Formerly Incarcerated Women and Girls, said in an interview with Rewire that solutions must go beyond allowing women to escape police custody and return home to communities that are often fragmented, unhealthy, and dangerous.

Underserved women, James said, need access to healing, transformative environments. She cited as an example the Brookview House, which helps women overcome addiction, untreated trauma, and homelessness.

James, who has advocated against the criminalization of drug use and prostitution, as well as the injustices faced by those in poverty, said the problem of jail misuse could benefit from the insight of real experts on the issue: women and girls who have been incarcerated.

These women and youth, she said, could help researchers better understand the “experiences that brought them to the bunk.”

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