(CORRECTION) AAP’s “Sexuality, Contraception, and the Media:” What’s Included and What’s Missing?

Bianca I. Laureano

The American Association of Pediatrics makes a statement on youth, contraception, sexuality, and media. Do they get it right?

This article was changed at 7:42 am on Friday, September 17th, to correct an error in the title, which incorrectly referred to AAP as APA.  It is the American Association of Pediatrics (AAP). We regret the error.

Before school was back in session for the fall, the American Association of Pediatrics (AAP) released a revised statement regarding youth, sexuality, contraception and media consumption. The statement was published online on August 30, 2010 and in print on September 3, 2010 in the Pediatrics journal. “Sexuality, Contraception, and the Media” with lead author Victor C. Strasburger, MD, is not a new discussion for the AAP, as they made a similar statement, with the same title, almost 10 years ago

In short, the AAP, states that the media (television, music, movies, magazines, and the Internet) impacts the perspectives and education youth receive regarding birth control, sexuality, and choices in general. They make eight recommendations for what pediatricians can do to be more useful and effective sources of information and care for their clients. The eight recommendations include:

1.    Include at least two questions about the media during intake.

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2.    Pediatricians should (yes they used that term) counsel parents and guardians on the importance/impact of the media, helping them recognize the access their child has not only to TV, but the Internet and social networking sites.

3.    Pediatricians and other groups should advocate and demand media create messages that are more responsible in their representations of sexual and reproductive health.

4.    Pediatricians should encourage schools to incorporate comprehensive sexuality education and media literacy into their curricula.

5.    Pediatricians should also advocate for the advertisement of birth control including emergency contraception.

6.    Pediatricians should advocate that advertisements for erectile dysfunction ads on television be limited after 10pm.

7.    Pediatricians should advocate to the broadcast media to provide “healthy” messages of sex and sexuality in their programming.

8.    Pediatricians should partner with various non-governmental organizations, community organizations and the government to do further research on the impact of the media on youth and their sexual health choices.

I’ll admit that I was not expecting too much from the AAP. One of the main reasons I didn’t have high expectations is because often when membership organizations make statements about issues that may intersect with their field, they don’t always “get it” right. To be honest, the main thing that stood out to me about this list of recommendations and the overall statement was the incorporation of media literacy. For me, there is media literacy and then there is media justice.  AAP is making a good first step in recognizing the importance of having our youth be literate and critical consumers of media. As an educator, I often include media literacy in my syllabus and have done so in all of my syllabi over the past 4 years. Yet, do they consider a media justice approach for the future?

I’m also impressed at the encouragement AAP provides its members to become activists in their community with educators, and schools, but also nationally and internationally with reaching out to media representatives. Areas that I think is not addressed are issues of access and class. How are youth who do not have access to certain types of media not being reached in general? If we are to look at how certain media is being used, how MTV is now partnering with social media outlets or the Minnesota Family Planning and STD Hotline is incorporating, these require 1. access to cable television (MTV specifically), 2. access to the Internet, and 3. access to a cell phone.

Last week I introduced theory to my sociology students. We discussed modernism and post-modernism and one of the ways I explained post-modernism was “mo’ money, mo’ problems.” (Ride with me all you post-modernists, I’m trying to give them a flavor of various theories, attract them to it). If we assume that more “choices” leads to more “freedom” does it really matter when those choices don’t even reach the most under-resourced groups? What does the “freedom” of those communities not reached look like if they aren’t even given the choice in the first place?

I write that to connect this idea of reaching youth in various ways, specifically the media, and to examine what types of media may not be included. Just as the AAP has argued emergency contraception rarely, if ever (I’ve never seen an ad on TV), gets airtime on television, there are many types of media that do not reach our youth. There is also an odd link to the direct-to-consumer advertising by pharmaceutical companies that is supported in this suggestion. The suggestion to limit erectile dysfunction advertisement may not be the most supported recommendation as many physicians who do such work may still be associated, invested, and paid by pharmaceutical companies. I also wonder what the AAP may think of the net neutrality debate, where it may take a position on such issues that may arise. Would they support a open Internet or a regulated one?

Roundups Sexual Health

This Week in Sex: A Nursing Home With a Healthy Attitude Toward Sex

Martha Kempner

A nursing home understands that its elderly residents are still sexual beings; New York City is amping up its youth sexual health outreach with emojis of eggplants and monkeys; and if forced to choose between eating and sex, a good number of people pick food.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Sex Is Not Just for the Young

The New York Times recently profiled a nursing home with a sex-positive attitude for its residents. The Hebrew Home at Riverdale adopted its “sexual expression policy” in 1995 after a nurse walked in on two residents having sex. She asked her boss, Daniel Reingold, what she should do. He said, “Tiptoe out and close the door.”

Reingold, the president of RiverSpring Health (which runs the nursing home), said that aging includes a lot of loss—from the loss of spouses and friends to the loss of independence and mobility. But he believes the loss of physical touch and intimacy does not have to be part of getting older.

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The policy acknowledges that residents have the right to seek out and engage in consensual acts of sexual expression with other residents or with visitors. The policy ensures that staff understand that their role is not to prevent sexual contact. In fact, some of the staff like to play cupid for residents. Audrey Davison, an 85-year-old resident, said that the staff let her sleep in her boyfriend’s room, and one aide even made them a “Do Not Disturb” sign for his door. She added: “I enjoyed it and he was a very good lover.”

Still, there are complicating factors to dating in nursing homes or assisted-living facilities. Some residents may be married to people who don’t live in the facility, and others may be suffering from memory loss, dementia, or Alzheimer’s, which can raise issues of consent. Hebrew Home’s policy states that Alzheimer’s patients can give consent under certain circumstances.

Though not all nursing homes have formal policies about sex, many acknowledge that their residents are or want to be sexually active and are working to help residents have a safe and consensual experience. Dr. Cheryl Phillips, a senior vice president at LeadingAge, an organization which represents nursing homes and others who provide elder care, also told the New York Times that this generation of older adults is different: “They’ve been having sex—that’s part of who they are—and just because they’re moving into a nursing home doesn’t mean they’re going to stop having sex.”

Of course, not all residents are lucky in love when they move in. Hebrew Home says that about 40 of its 870 residents are in relationships. Staff are trying to help the others. They set up happy hours, a prom, and have started a dating service called G-Date (for “Grandparent Date”). So far it hasn’t been too successful in making matches, but the staff is convinced that someday their efforts will pay off with a wedding.

Can Emojis Connect Youth to Sexual Health Services?

New York City’s public hospital system, known as Health & Hospitals, provides confidential sexual health services—including pregnancy tests, contraception, and tests for sexually transmitted diseases (STDs)—for young people 12 and older regardless of their ability to pay, immigration status, or sexual orientation. Health & Hospitals served 152,000 patients last year, but its leaders think it could do even more if more young people were aware of the services offered.

As a way to speak the language of young people, Health & Hospitals launched a campaign starring emojis in July.

The emojis are expected to reach 2.4 million young people in New York City through social media including Facebook and Instagram. The emojis include an eggplant, a monkey covering his eyes, and, of course, some birds and bees. The online ads read, “Need someone to talk to about ‘it’?”

When young people click on the emojis, they will be taken to the Health & Hospitals youth website, which explains available services and how to find accessible providers.

Dr. Ram Raju, president and CEO of NYC Health & Hospitals, said in a press release that the organization provides nonjudgmental services to youth: “Whether it’s birth control, pregnancy testing, emergency contraception or depression screening, the public health system has affordable services in local community health centers, where we speak your language, understand your culture and respect your privacy.”

But some worry that these emojis are confusing. Elizabeth Schroeder, a sex educator and trainer, told the New York Times that while she applauded the effort, she questioned if the images chosen were the best to convey the message.

We here at This Week in Sex have to agree and admit the images confuse us as well. The monkey is cute, but what does it have to do with STDs?

Choosing Between Appetites, Many Pick Food

Good food or good sex? These two sources of pleasure are rarely at odds with each other, but if they ever are, which would you choose?

A new survey, by advertising agency Havas Worldwide, posed this very question to almost 12,000 adults in 37 countries across the globe. The results show that about half of adults (46 percent of men and 51 percent of women) believe that food can be as pleasurable as sex. And one-third would choose a great dinner at a restaurant rather than sex; women were more likely to make this choice (42 percent compared with 26 percent of men).

Millennials were also more likely to make this choice than those slightly older Gen-Xers (35 percent to 30 percent). Of course, it’s hard to tell whether this says more about their sex lives or their eating habits.

 

News Law and Policy

Texas Lawmaker’s ‘Coerced Abortion’ Campaign ‘Wildly Divorced From Reality’

Teddy Wilson

Anti-choice groups and lawmakers in Texas are charging that coerced abortion has reached epidemic levels, citing bogus research published by researchers who oppose legal abortion care.

A Texas GOP lawmaker has teamed up with an anti-choice organization to raise awareness about the supposed prevalence of forced or coerced abortion, which critics say is “wildly divorced from reality.”

Rep. Molly White (R-Belton) during a press conference at the state capitol on July 13 announced an effort to raise awareness among public officials and law enforcement that forced abortion is illegal in Texas.

White said in a statement that she is proud to work alongside The Justice Foundation (TJF), an anti-choice group, in its efforts to tell law enforcement officers about their role in intervening when a pregnant person is being forced to terminate a pregnancy. 

“Because the law against forced abortions in Texas is not well known, The Justice Foundation is offering free training to police departments and child protective service offices throughout the State on the subject of forced abortion,” White said.

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White was joined at the press conference by Allan Parker, the president of The Justice Foundation, a “Christian faith-based organization” that represents clients in lawsuits related to conservative political causes.

Parker told Rewire that by partnering with White and anti-choice crisis pregnancy centers (CPCs), TJF hopes to reach a wider audience.

“We will partner with anyone interested in stopping forced abortions,” Parker said. “That’s why we’re expanding it to police, social workers, and in the fall we’re going to do school counselors.”

White only has a few months remaining in office, after being defeated in a closely contested Republican primary election in March. She leaves office after serving one term in the state GOP-dominated legislature, but her short time there was marked by controversy.

During the Texas Muslim Capitol Day, she directed her staff to “ask representatives from the Muslim community to renounce Islamic terrorist groups and publicly announce allegiance to America and our laws.”

Heather Busby, executive director of NARAL Pro-Choice Texas, said in an email to Rewire that White’s education initiative overstates the prevalence of coerced abortion. “Molly White’s so-called ‘forced abortion’ campaign is yet another example that shows she is wildly divorced from reality,” Busby said.

There is limited data on the how often people are forced or coerced to end a pregnancy, but Parker alleges that the majority of those who have abortions may be forced or coerced.

‘Extremely common but hidden’

“I would say that they are extremely common but hidden,” Parker said. “I would would say coerced or forced abortion range from 25 percent to 60 percent. But, it’s a little hard be to accurate at this point with our data.”

Parker said that if “a very conservative 10 percent” of the about 60,000 abortions that occur per year in Texas were due to coercion, that would mean there are about 6,000 women per year in the state that are forced to have an abortion. Parker believes that percentage is much higher.

“I believe the number is closer to 50 percent, in my opinion,” Parker said. 

There were 54,902 abortions in Texas in 2014, according to recently released statistics from the Texas Department of State Health Services (DSHS). The state does not collect data on the reasons people seek abortion care. 

White and Parker referenced an oft cited study on coerced abortion pushed by the anti-choice movement.

“According to one published study, sixty-four percent of American women who had abortions felt forced or unduly pressured by someone else to have an unwanted abortion,” White said in a statement.

This statistic is found in a 2004 study about abortion and traumatic stress that was co-authored by David Reardon, Vincent Rue, and Priscilla Coleman, all of whom are among the handful of doctors and scientists whose research is often promoted by anti-choice activists.

The study was cited in a report by the Elliot Institute for Social Sciences Research, an anti-choice organization founded by Reardon. 

Other research suggests far fewer pregnant people are coerced into having an abortion.

Less than 2 percent of women surveyed in 1987 and 2004 reported that a partner or parent wanting them to abort was the most important reason they sought the abortion, according to a report by the Guttmacher Institute.

That same report found that 24 percent of women surveyed in 1987 and 14 percent surveyed in 2004 listed “husband or partner wants me to have an abortion” as one of the reasons that “contributed to their decision to have an abortion.” Eight percent in 1987 and 6 percent in 2004 listed “parents want me to have an abortion” as a contributing factor.

‘Flawed research’ and ‘misinformation’  

Busby said that White used “flawed research” to lobby for legislation aimed at preventing coerced abortions in Texas.

“Since she filed her bogus coerced abortion bill—which did not pass—last year, she has repeatedly cited flawed research and now is partnering with the Justice Foundation, an organization known to disseminate misinformation and shameful materials to crisis pregnancy centers,” Busby said.  

White sponsored or co-sponsored dozens of bills during the 2015 legislative session, including several anti-choice bills. The bills she sponsored included proposals to increase requirements for abortion clinics, restrict minors’ access to abortion care, and ban health insurance coverage of abortion services.

White also sponsored HB 1648, which would have required a law enforcement officer to notify the Department of Family and Protective Services if they received information indicating that a person has coerced, forced, or attempted to coerce a pregnant minor to have or seek abortion care.

The bill was met by skepticism by both Republican lawmakers and anti-choice activists.

State affairs committee chairman Rep. Byron Cook (R-Corsicana) told White during a committee hearing the bill needed to be revised, reported the Texas Tribune.

“This committee has passed out a number of landmark pieces of legislation in this area, and the one thing I think we’ve learned is they have to be extremely well-crafted,” Cook said. “My suggestion is that you get some real legal folks to help engage on this, so if you can keep this moving forward you can potentially have the success others have had.”

‘Very small piece of the puzzle of a much larger problem’

White testified before the state affairs committee that there is a connection between women who are victims of domestic or sexual violence and women who are coerced to have an abortion. “Pregnant women are most frequently victims of domestic violence,” White said. “Their partners often threaten violence and abuse if the woman continues her pregnancy.”

There is research that suggests a connection between coerced abortion and domestic and sexual violence.

Dr. Elizabeth Miller, associate professor of pediatrics at the University of Pittsburgh, told the American Independent that coerced abortion cannot be removed from the discussion of reproductive coercion.

“Coerced abortion is a very small piece of the puzzle of a much larger problem, which is violence against women and the impact it has on her health,” Miller said. “To focus on the minutia of coerced abortion really takes away from the really broad problem of domestic violence.”

A 2010 study co-authored by Miller surveyed about 1,300 men and found that 33 percent reported having been involved in a pregnancy that ended in abortion; 8 percent reported having at one point sought to prevent a female partner from seeking abortion care; and 4 percent reported having “sought to compel” a female partner to seek an abortion.

Another study co-authored by Miller in 2010 found that among the 1,300 young women surveyed at reproductive health clinics in Northern California, about one in five said they had experienced pregnancy coercion; 15 percent of the survey respondents said they had experienced birth control sabotage.

‘Tactic to intimidate and coerce women into not choosing to have an abortion’

TJF’s so-called Center Against Forced Abortions claims to provide legal resources to pregnant people who are being forced or coerced into terminating a pregnancy. The website includes several documents available as “resources.”

One of the documents, a letter addressed to “father of your child in the womb,” states that that “you may not force, coerce, or unduly pressure the mother of your child in the womb to have an abortion,” and that you could face “criminal charge of fetal homicide.”

The letter states that any attempt to “force, unduly pressure, or coerce” a women to have an abortion could be subject to civil and criminal charges, including prosecution under the Federal Unborn Victims of Violence Act.

The document cites the 2007 case Lawrence v. State as an example of how one could be prosecuted under Texas law.

“What anti-choice activists are doing here is really egregious,” said Jessica Mason Pieklo, Rewire’s vice president of Law and the Courts. “They are using a case where a man intentionally shot his pregnant girlfriend and was charged with murder for both her death and the death of the fetus as an example of reproductive coercion. That’s not reproductive coercion. That is extreme domestic violence.”

“To use a horrific case of domestic violence that resulted in a woman’s murder as cover for yet another anti-abortion restriction is the very definition of callousness,” Mason Pieklo added.

Among the other resources that TJF provides is a document produced by Life Dynamics, a prominent anti-choice organization based in Denton, Texas.

Parker said a patient might go to a “pregnancy resource center,” fill out the document, and staff will “send that to all the abortionists in the area that they can find out about. Often that will stop an abortion. That’s about 98 percent successful, I would say.”

Reproductive rights advocates contend that the document is intended to mislead pregnant people into believing they have signed away their legal rights to abortion care.

Abortion providers around the country who are familiar with the document said it has been used for years to deceive and intimidate patients and providers by threatening them with legal action should they go through with obtaining or providing an abortion.

Vicki Saporta, president and CEO of the National Abortion Federation, previously told Rewire that abortion providers from across the country have reported receiving the forms.

“It’s just another tactic to intimidate and coerce women into not choosing to have an abortion—tricking women into thinking they have signed this and discouraging them from going through with their initial decision and inclination,” Saporta said.

Busby said that the types of tactics used by TFJ and other anti-choice organizations are a form of coercion.

“Everyone deserves to make decisions about abortion free of coercion, including not being coerced by crisis pregnancy centers,” Busby said. “Anyone’s decision to have an abortion should be free of shame and stigma, which crisis pregnancy centers and groups like the Justice Foundation perpetuate.”

“Law enforcement would be well advised to seek their own legal advice, rather than rely on this so-called ‘training,” Busby said.

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