Last week, the Irish Family Planning Association held that country's first ever Young Decision Makers' (YDM) conference in Dublin. Following a model established in successful YDM meetings in Portugal, Spain, and Finland, the Irish YDM marks a two-front effort to scale up advocacy for sexual and reproductive health and rights (SRHR) in a country that has traditionally been seen as a bit behind on these issues (especially when compared to other countries on the continent).
First, the YDM model serves to mobilize young decision makers—members of political parties, those holding elected positions, and other well-situated advocates—at the country level to advocate for better national policies on a wide array of SRHR issues. Given the age of these advocates, policies affecting youth are naturally prominent, if not paramount, on the agenda.
Second, the YDM meetings are explicitly coordinated to bridge concern about national issues to equal concern with the role of governments as donors in promoting and prioritizing SRHR in developing parts of the world. This is, of course, all the more important in the current global climate as U.S. shenanigans that undermine SRHR at every turn mean we've got to rely on other donor countries to fill the decency gap. Consider the lackluster support by the U.S. for condoms in combating HIV/AIDS in sub-Saharan Africa—that gap becomes a public health nightmare that other donors must repair.
Youth issues are particularly crucial for the Irish as more than 1/3 of their population is under the age of 25 (larger than the European Union average of about 29 percent). And, the time may be right for change. The law currently makes all sex under the age of 17 illegal (of course, it is worth mentioning that most teens in Ireland initiate sex at or before 16 years of age, thus this "crime" is pervasive on the Emerald Isle). A recent Supreme Court decision, however, means that this law must be reconsidered.
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Thankfully, along with the fertile ground for a realistic change in outdated laws, Ireland's approach to sex education is more progressive than most might think. In 1995, Ireland instituted a nationwide program called Relationships and Sexuality Education (RSE) which aimed to "promote an understanding of sexuality" and "healthy attitudes and values toward their sexuality in a moral, spiritual and social framework." The language itself is startling, particularly for Americans who cannot even get new, supposedly progressive, Democratic leaders in the U.S. Congress to drop the tired mantra of teen pregnancy prevention as the rationale for why young people need sexuality information. The Irish are light years ahead.
The program is not perfect, however. Research released earlier this year which was presented at the conference, sheds light on the fact that RSE's implementation is falling short of desired outcomes. Problems of oversight on implementation, poor teacher training, and the universal scourge of discomfort in addressing sexuality issues with young people, remain significant obstacles. Yet, Ireland's national program far surpasses anything we have in the United States and makes the Bush administration's promotion of abstinence-only programs look appropriately like 18th century thinking. And, surprise, surprise: participants at the YDM reported that abstinence-only-until-marriage programs are gaining access to Irish schools and providing incorrect and religiously themed programs.
The young decision makers gathered in Dublin last week also spoke about the need for basic reproductive health care services, including legal abortion. Advocates in Ireland continue to battle for the right to choose and a new innovative campaign, Safe and Legal, has been launched to galvanize and magnify these efforts.
One thing that struck me in Ireland and that was raised at the YDM was the issue of access to condoms. It is not that they cannot be found. This American likes a pint of Guinness as much as any Irishman and in each pub I ventured into, condom machines were in each of the restrooms (or the jacks, as they call them). The issue in the urban areas is thus not so much access as it is price (though access and price are issues outside of urban hubs). The price of a condom in the average pub is about 4 Euros—about the same price as an additional pint. That's a problem. Cost is high in pharmacies as well. Part of this problem is that condoms are taxed as a luxury item in Ireland which means they cost 10 to 20 percent more than they should. The YDM shed light on this and a change in the rate of taxation on condoms, at a minimum, is essential.
Going forward, the young decision makers gathered in Ireland will be creating a statement of priorities to move country-level policy. With the creation of an organized group of young decision makers in the country, these priorities have an actualizing element that can make a difference. European countries need these types of groups in this important time of transition and expansion of the European Union. Indeed, other counter forces are at work in countries like Poland and in Brussels to turn back the clock on SRHR. Let's make sure they don't get a free ride.
Rep. Marsha Blackburn (R-TN) justified her recent subpoenas of a prominent later abortion provider and first responders in the community where he works by pointing to “public reports” that people who sought abortion care from the doctor required hospital transfers.
Hospital transfers are not necessarily a cause for alarm, multiple sources told Rewire. In fact, the rare instances signal a continued commitment to appropriate patient care that begins in an abortion clinic. A patient may not require further treatment upon arrival at the hospital, indicating a proactive clinic rather than a dangerous one. Regardless of the circumstances, anti-choice activists often hijack so-called emergencies to fuel their coverage of the alleged dangers of abortion care.
Freestanding clinics manage most immediate abortion-related complications, including those that occur during later abortions, said Dr. Daniel Grossman, a provider and professor in the department of obstetrics, gynecology, and reproductive services at the University of California, San Francisco.
Abortion-related complications are rare throughout all stages of pregnancy. The even rarer event that such complications necessitate a hospital transfer doesn’t indicate the work of a bad abortion provider, Grossman explained in an interview with Rewire.
“There are sometimes things that happen that are unforeseeable,” he said.
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Grossman, his University of California, San Francisco colleague Dr. Ushma Upadhyay, and other reproductive health care practitioners and policy experts studied just how often those unforeseeable instances occur in a review of nearly 55,000 abortions covered under the fee-for-service California Medicaid program from 2009-2010. The state data allowed researchers to track subsequent follow-up care sought after an abortion.
Among all abortions, about one of 5,491, or 0.03 percent, involved ambulance transfers to emergency departments on the day of the procedure, the researchers found.
For procedures in the second trimester or later, major complications that required hospital admissions, blood transfusions, or surgery amounted to 34 cases, or 0.41 percent.
Many hospitals don’t provide abortions, which essentially forces providers to perform the procedure at a freestanding clinic or turn away patients, Grossman said. Providers would not do something unsafe, he stressed, “but that puts a lot of pressure on them because they don’t have that option of deciding to do the procedure of a higher-risk patient in a hospital.”
Data supports Grossman’s assessment about abortion and clinic safety. Abortion care is one of the safest medical procedures performed in the United States, according to Planned Parenthood and the American Congress of Obstetricians and Gynecologists. “The rate of complications increases as a woman’s pregnancy continues, but these complications remain very unlikely,” the groups said in a joint fact sheet.
Blackburn, the chair of the U.S. House of Representatives’ Select Investigative Panel on Infant Lives, framed such instances differently when she shifted the panel’s focus from fetal tissue research practices to later abortion care, issuing subpoenas in mid-May to Dr. LeRoy Carhart and various local and state entities in Maryland.
“Public reports indicate at least five women have been sent to the hospital since December while seeking an abortion in this clinic,” Blackburn said in a press release. Blackburn expressed concern for “the sake of the women who have been rushed from that clinic to the hospital with increasing frequency.”
Blackburn Allegations Rooted in Dubious Sources
Blackburn’s press release cited the five hospital transfers since December 2015, but her subpoenas demand documentation dating back to 2010—signaling a deeper scope to her investigation.
The National Abortion Federation (NAF), the professional association of abortion providers, countered Blackburn’s basis for the subpoenas.
“Abortion opponents have been targeting Dr. Carhart for years because he is a very vocal and visible abortion provider,” NAF spokesperson Melissa Fowler told Rewire in an email. Following the 2009 murder of Dr. George Tiller, Carhart arguably became the country’s most prominent provider of later abortion care.
The Maryland Board of Physicians, one of the targets of Blackburn’s subpoenas, indicates that Carhart is in good standing. The board’s online practitioner profile system lists no Maryland disciplinary actions, no pending charges, and no reported malpractice judgments and arbitration awards within the past ten years. Malpractice settlements are another measure of provider competence, and Carhart hasn’t had three or more malpractice settlements of at least $150,000 in the past five years, according to the system. Additionally, the courts have not reported “convictions for any crime involving moral turpitude,” which the board defines as “conduct evidencing moral baseness” and determines on an individual basis under common law.
Absent allegations on the board’s website, the “public reports” smearing Carhart appear to come from anti-choice news outlets. In March, LifeSiteNews.com cited eyewitness accounts from anti-choice activists in reporting that Carhart sent a fourth woman to the hospital in four months. A leader of the radical anti-choice group Operation Rescue covered the same allegationsfor LifeNews.com.
The same website in 2013 alleged that the Washington Post downplayed the death of a young womanwho sought a later abortion at the clinic. However, the Maryland medical examiner’s office found that the woman died of natural causes from a rare complication that can also occur in conjunction with childbirth, and state health officials found “no deficiencies” in the care she received at the clinic. Blackburn’s subpoenas include Adventist HealthCare Shady Grove Medical Center, formerly Shady Grove Adventist Hospital, where the woman died.
Anti-choice organizations and their reports have played a prominent role in the current congressional inquiry. Troy Newman, Operation Rescue’s president, and David Daleiden founded the Center for Medical Progress (CMP), the anti-choice front group that triggered the select panel’s investigation into allegations that Planned Parenthood profited from fetal tissue donations obtained from abortions.
Blackburn’s select panel spokesperson denied that the subpoenas are based on information from anti-choice sources.
“The subpoenas we issued are not based on the sources you have cited,” the spokesperson told Rewire in an email. “However, due to confidentiality agreements, we are not at liberty to disclose the identities of our sources.”
Anti-Choice Activists Hijack Emergencies
Although Blackburn’s evidence may come from different sources, the fact remains that Operation Rescue and other radical anti-choice activists are known for surveilling abortion clinicsand making repeated records requests, all to report similar claims about botched abortions necessitating hospital transfers.
duVergne Gaines, director of the Feminist Majority Foundation’s National Clinic Access Project, said surveillance tactics enable anti-choice activists not only to photograph and video emergency responders, but also follow up with Freedom of Information Act and equivalent state-level requests for records, including 9-1-1 tapes, if state laws permit their release.
“They collect data,” Gaines said in an interview. “They put that up on the websites themselves, on their own Facebook pages, and have no real knowledge about what or why an ambulance may have been contacted.”
Hospital transfers in some instances have nothing to do with the procedure. Contrary to initial anti-choice accounts, the Lincoln, Nebraska Journal Starreported that a woman transferred in 2015 from a local Planned Parenthood to a hospital “wasn’t suffering complications from an abortion, but had instead sought help at the clinic after being assaulted at her home nearby.”
At times, anti-choice activists may manufacture emergency scenarios, Gaines said. “The most obvious example is alleging that a minor is inside being forced to undergo a procedure against her will, and that can happen if they see a minor go in [to a clinic],” she said.
Rewirereported in March that police appeared at a Mississippi clinic and threatened to charge a single mother with fetal homicide after her daughter, a minor seeking a legal abortion, signed a bogus Life Dynamics document stating that she was being coerced into the procedure.
The prominent anti-choice group uses the document to deceive and intimidate patients and providers by threatening legal action should they go through with obtaining or providing abortion care.
NAF President Vicki Saporta said that many of her group’s members have experienced anti-choice tactics such as staking out clinics for emergency vehicles, placing calls to summon emergency responders, and trailing ambulances to hospitals with the aim of gathering confidential patient information. Preferred tactics depend on the local anti-choice community, she said.
Saporta pointed to a crisis pregnancy center that opened in the same complex as the Germantown, Maryland, clinic where Carhart practices. A Germantown Pregnancy Choices, which comes up as the Maryland Coalition for Life when entered into Google Maps, operates within less than 200 feet of the clinic. The Maryland Coalition for Life cited eyewitness accounts and a videoin March to support allegations that an underage girl required a hospital transfer “due to medical emergencies related to a late term abortion.”
Anti-choice activists targeting clinics over safety share a common denominator. “Once their bogus claims are investigated, for the most part, no action is taken because nothing is actionable,” Saporta said.
Though the Real Education for Healthy Youth Act has little chance of passing Congress, its inclusive and evidence-based approach is a much-needed antidote to years of publicly funded abstinence-only-until-marriage programs, which may have contributed to troubling declines in youth knowledge about sexual and reproductive health.
Recent research from the Guttmacher Institute finds there have been significant changes in sexuality education during the last decade—and not for the better.
Fewer young people are receiving “formal sex education,” meaning classes that take place in schools, youth centers, churches, or community settings. And parents are not necessarily picking up the slack. This does not surprise sexuality education advocates, who say shrinking resources and restrictive public policies have pushed comprehensive programs—ones that address sexual health and contraception, among other topics—out of the classroom, while continued funding for abstinence-only-until-marriage programs has allowed uninformative ones to remain.
But just a week before this research was released in April, Sen. Cory Booker (D-NJ) introduced the Real Education for Healthy Youth Act (REHYA). If passed, REHYA would allocate federalfunding for accurate, unbiased sexuality education programs that meet strict content requirements. More importantly, it would lay out a vision of what sexuality education could and should be.
Can this act ensure that more young people get high-quality sexuality education?
In the short term: No. Based on the track record of our current Congress, it has little chance of passing. But in the long run, absolutely.
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Less Sexuality Education Today The Guttmacher Institute’s new study compared data from two rounds of a national survey in the years 2006-2010 and 2011-2013. It found that even the least controversial topics in sex education—sexually transmitted diseases (STDs) and HIV and AIDS—are taught less today than a few years ago. The proportion of young women taught about STDs declined from 94 percent to 90 percent between the two time periods, and young women taught about HIV and AIDS declined from 89 percent to 86 percent during the same period.
While it may seem like a lot of young people are still learning about these potential consequences of unprotected sex, few are learning how to prevent them. In the 2011-2013 survey, only 50 percent of teen girls and 58 percent of teen boys had received formal instruction about how to use a condom before they turned 18. And the percentage of teens who reported receiving formal education about birth control in general decreased from 70 percent to 60 percent among girls and from 61 percent to 55 percent among boys.
One of the only things that did increase was the percentage of teen girls (from 22 percent to 28 percent) and boys (from 29 to 35 percent) who said they got instruction on “how to say no to sex”—but no corresponding instruction on birth control.
Unfortunately, many parents do not appear to be stepping in to fill the gap left by formal education. The study found that while there’s been a decline in formal education, there has been little change in the number of kids who say they’ve spoken to their parents about birth control.
Debra Hauser, president of Advocates for Youth, told Rewire that this can lead to a dangerous situation: “In the face of declining formal education and little discussion from their parents, young people are left to fend for themselves, often turning to their friends or the internet-either of which can be fraught with trouble.”
The study makes it very clear that we are leaving young people unprepared to make responsible decisions about sex. When they do receive education, it isn’t always timely: It found that in 2011-2013, 43 percent of teen females and 57 percent of teen males did not receive information about birth control before they had sex for the first time.
It could be tempting to argue that the situation is not actually dire because teen pregnancy rates are at a historic low, potentially suggesting that young people can make do without formal sex education or even parental advice. Such an argument would be a mistake. Teen pregnancy rates are dropping for a variety of reasons, but mostly because because teens are using contraception more frequently and more effectively. And while that is great news, it is insufficient.
Our goals in providing sex education have to go farther than getting young people to their 18th or 21st birthday without a pregnancy. We should be working to ensure that young people grow up to be sexually healthy adults who have safe and satisfying relationships for their whole lives.
But for anyone who needs an alarming statistic to prove that comprehensive sex education is still necessary, here’s one: Adolescents make up just one quarter of the population, but the Centers for Disease Control and Prevention estimate they account for more than half of the 20 million new sexually transmittedinfections (STIs) that occur each year in this country.
The Real Education for Healthy Youth Act The best news about the REHYA is that it takes a very broad approach to sexuality education, provides a noble vision of what young people should learn, and seems to understand that changes should take place not just in K-12 education but through professional development opportunities as well.
As Advocates for Youth explains, if passed, REHYA would be the first federal legislation to ever recognize young people’s right to sexual health information. It would allocate funding for education that includes a wide range of topics, including communication and decision-making skills; safe and healthy relationships; and preventing unintended pregnancy, HIV, other STIs, dating violence, sexual assault, bullying, and harassment.
In addition, it would require all funded programs to be inclusive of lesbian, gay, bisexual, and transgender students and to meet the needs of young people who are sexually active as well as those who are not. The grants could also be used for adolescents and young adults in institutes of higher education. Finally, the bill recognizes the importance of teacher training and provides resources to prepare sex education instructors.
If we look at the federal government’s role as leading by example, then REHYA is a great start. It sets forth a plan, starts a conversation, and moves us away from decades of focusing on disproven abstinence-only-until-marriage programs. In fact, one of the fun parts of this new bill is that it diverts funding from the Title V program, which received $75 million dollars in Fiscal Year 2016. That funding has supported programs that stick to a strict eight-point definition of “abstinence education” (often called the “A-H definition”) that, among other things, tells young people that sex outside of marriage is against societal norms and likely to have harmful physical and psychological effects.
The federal government does not make rules on what can and cannot be taught in classrooms outside of those programs it funds. Broad decisions about topics are made by each state, while more granular decisions—such as what curriculum to use or videos to show—are made by local school districts. But the growth of the abstinence-only-until-marriage approach and the industry that spread it, researchers say, was partially due to federal funding and the government’s “stamp of approval.”
Heather Boonstra, director of public policy at the Guttmacher Institute and a co-author of its study, told Rewire: “My sense is that [government endorsement] really spurred the proliferation of a whole industry and gave legitimacy—and still does—to this very narrow approach.”
The money—$1.5 billion total between 1996 and 2010—was, of course, at the heart of a lot of that growth. School districts, community-based organizations, and faith-based institutions created programs using federal and state money. And a network of abstinence-only-until-marriage organizations grew up to provide the curricula and materials these programs needed. But the reach was broader than that: A number of states changed the rules governing sex education to insist that schools stress abstinence. Some even quoted all or part of the A-H definition in their state laws.
REHYA would provide less money to comprehensive education than the abstinence-only-until-marriage funding streams did to their respective programs, but most advocates agree that it is important nonetheless. As Jesseca Boyer, vice president at the Sexuality Information and Education Council of the United States (SIECUS), told Rewire, “It establishes a vision of what the government could do in terms of supporting sex education.”
Boonstra noted that by providing the model for good programs and some money that would help organizations develop materials for those programs, REHYA could have a broader reach than just the programs it would directly fund.
The advocates Rewire spoke with agree on something else, as well: REHYA has very little chance of passing in this Congress. But they’re not deterred. Even if it doesn’t become law this year, or next, it is moving the pendulum back toward the comprehensive approach to sex education that our young people need.
CORRECTION: This article has been updated to clarify Jesseca Boyer’s position at the Sexuality Information and Education Council of the United States.