Analysis Sexual Health

For LGBT Health, What Happens in Wisconsin Shouldn’t Stay in Wisconsin

Kenneth Katz

A recent study on LGBT healthcare in Wisconsin underscores the importance of passing a proposed law in California to improve the health of its LGBT residents. In doing so, California can teach Wisconsin a thing or two.

April is STD Awareness month.  This article is one in a series published by Rewire in partnership with the National Coalition of STD Directors, focused on aspects of STD prevention, treatment and funding and the public health implications of neglecting STDs.

What happens in Wisconsin matters in California. And I’m not talking about the union wars.

What I am talking about, rather, is a recently published Wisconsin study, and what that study means for a bill related to lesbian, gay, bisexual, and transgender (LGBT) health that the California State Senate is now considering.

In the Wisconsin study, 271 HIV-negative gay and bisexual men were asked whether their doctor knew they engaged in same-sex sexual behavior, and whether their doctor had followed Centers for Disease Control and Prevention (CDC) guidelines by recommending testing for sexually transmitted diseases (STDs) and HIV and vaccination against hepatitis A and B.

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The results:

  • Only about 30 percent said their doctors knew that they engaged in same-sex sexual behavior.
  • Among men whose doctors knew that they engaged in same-sex sexual behavior, doctors recommended HIV testing, STD testing, and hepatitis A or B vaccination in only 59 percent, 50 percent, and 32 percent of cases, respectively. 
  • Men whose doctors did not know that they engaged in same-sex sexual behavior were much less likely to get those recommendations – four times less likely for HIV testing, three times less likely for STD testing, and two times less likely for hepatitis A and B vaccination.

The Wisconsin study is not the first to document deficiencies in LGBT healthcare, particularly for LGBT persons who have not disclosed their orientation to their doctors. But it is concerning, especially since men who have sex with men in the U.S., according to CDC, are over 40 times more likely than straight men to get HIV and syphilis. A host of other health concerns – some related to sexual health, some not – are also specific to LGBT persons.

The nation has taken notice.

The federal government’s Healthy People 2020 program specifically targets LGBT health, as does a recent Institute of Medicine report. The American Medical Association (AMA) has recognized that LGBT persons have unique healthcare needs and face substantial health disparities.

That brings us back to the California State Senate, which now has an important opportunity to act to improve LGBT health.

California Senate Bill 747 (SB 747) would require licensed healthcare providers – including physicians, nurses, and others – to complete a two- to five-hour course on cultural competency, sensitivity, and best practices for providing adequate care to LGBT persons. The content of the course would be modeled on continuing education materials developed by the Gay and Lesbian Medical Association (GLMA).

SB 747 was introduced by State Sen. Christine Kehoe (D-San Diego) in February and is sponsored by Equality California, an LGBT advocacy organization. Supporters include numerous healthcare providers and individuals and eight other organizations, including the California STD Controllers Association and GLMA.

Four clinicians’ associations in California have registered formal opposition to the bill, arguing (variously) that clinical training programs already adequately address LGBT health issues, that educational requirements should be directed only to training programs or to primary care doctors, or that states should not impose any content-specific continuing education requirements.

Those arguments don’t stand up.

First, LGBT health is not an educational priority in U.S. medical schools. Over half of medical schools surveyed in 1998 included no information about LGBT persons. And a quarter of medical schools surveyed in 2003 taught about sexual health, including taking a sexual history, for only six or fewer hours.

Second, focusing on current trainees would miss older healthcare providers, who need it the most. Data from the Wisconsin study showed that older providers are, in fact, more likely not to know that their gay or bisexual patients engaged in same-sex sexual behaviors. Furthermore, LGBT health concerns span a wide spectrum of diseases and conditions and include aspects of care, such as patient intake forms, common to the vast majority of healthcare providers.

Third, the burden posed by the bill’s requirements is small, and it should be balanced against evidence suggesting that such requirements can in fact be effective. Education can improve knowledge and attitudes toward LGBT health. That’s why the AMA has launched educational outreach efforts to physicians regarding LGBT health, and the Wisconsin study investigators and others have recommended prioritizing LGBT education for all healthcare providers. Importantly, continuing education requirements for healthcare providers have effectively changed provider practice patterns in other areas of healthcare.

So far, fortunately, SB 747 is doing well. Earlier this month the State Senate’s Committee on Business, Professions and Economic Development voted 6-2 in favor of the bill. The bill’s next stop is a hearing before the Senate’s Appropriations Committee, set for May 2.

By enacting SB 747 into law, California can – and should – demonstrate its commitment to leading the nation in improving the health of its LGBT residents. In doing so, California can teach Wisconsin a thing or two.

Culture & Conversation Media

Filmmaker Tracy Droz Tragos Centers Abortion Stories in New Documentary

Renee Bracey Sherman

The film arrives at a time when personal stories are center stage in the national conversation about abortion, including in the most recent Supreme Court decision, and rightly so. The people who actually have and provide abortions should be driving the narrative, not misinformation and political rhetoric.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

A new film by producer and director Tracy Droz Tragos, Abortion: Stories Women Tell, profiles several Missouri residents who are forced to drive across the Mississippi River into Illinois for abortion care.

The 93-minute film features interviews with over 20 women who have had or are having abortions, most of whom are Missouri residents traveling to the Hope Clinic in Granite City, Illinois, which is located about 15 minutes from downtown St. Louis.

Like Mississippi, North Dakota, South Dakota, and Wyoming, Missouri has only one abortion clinic in the entire state.

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The women share their experiences, painting a more nuanced picture that shows why one in three women of reproductive age often seek abortion care in the United States.

The film arrives at a time when personal stories are center stage in the national conversation about abortion, including in the most recent U.S. Supreme Court decision, and rightly so. The people who actually have and provide abortions should be driving the narrative, not misinformation and political rhetoric. But while I commend recent efforts by filmmakers like Droz Tragos and others to center abortion stories in their projects, these creators still have far to go when it comes to presenting a truly diverse cadre of storytellers if they really want to shift the conversation around abortion and break down reproductive stigma.

In the wake of Texas’ omnibus anti-abortion law, which was at the heart of the Whole Woman’s Health v. Hellerstedt Supreme Court case, Droz Tragos, a Missouri native, said in a press statement she felt compelled to document how her home state has been eroding access to reproductive health care. In total, Droz Tragos interviewed 81 people with a spectrum of experiences to show viewers a fuller picture of the barriersincluding legislation and stigmathat affect people seeking abortion care.

Similar to HBO documentaries about abortion that have come before it—including 12th & Delaware and Abortion: Desperate ChoicesAbortion: Stories Women Tell involves short interviews with women who are having and have had abortions, conversations with the staff of the Hope Clinic about why they do the work they do, interviews with local anti-choice organizers, and footage of anti-choice protesters shouting at patients, along with beautiful shots of the Midwest landscape and the Mississippi River as patients make road trips to appointments. There are scenes of clinic escorts holding their ground as anti-choice protesters yell Bible passages and obscenities at them. One older clinic escort carries a copy of Living in the Crosshairs as a protester follows her to her car, shouting. The escort later shares her abortion story.

One of the main storytellers, Amie, is a white 30-year-old divorced mother of two living in Boonville, Missouri. She travels over 100 miles each way to the Hope Clinic, and the film chronicles her experience in getting an abortion and follow-up care. Almost two-thirds of people seeking abortions, like Amie, are already a parent. Amie says that the economic challenges of raising her other children make continuing the pregnancy nearly impossible. She describes being physically unable to carry a baby and work her 70 to 90 hours a week. Like many of the storytellers in the film, Amie talks about the internalized stigma she’s feeling, the lack of support she has from loved ones, and the fear of family members finding out. She’s resilient and determined; a powerful voice.

The film also follows Kathy, an anti-choice activist from Bloomfield, Missouri, who says she was “almost aborted,” and that she found her calling in the anti-choice movement when she noticed “Anne” in the middle of the name “Planned Parenthood.” Anne is Kathy’s middle name.

“OK Lord, are you telling me that I need to get in the middle of this?” she recalls thinking.

The filmmakers interview the staff of the Hope Clinic, including Dr. Erin King, a pregnant abortion provider who moved from Chicago to Granite City to provide care and who deals with the all-too-common protesting of her home and workplace. They speak to Barb, a talkative nurse who had an abortion 40 years earlier because her nursing school wouldn’t have let her finish her degree while she was pregnant. And Chi Chi, a security guard at the Hope Clinic who is shown talking back to the protesters judging patients as they walk into the clinic, also shares her abortion story later in the film. These stories remind us that people who have abortions are on the frontlines of this work, fighting to defend access to care.

To address the full spectrum of pregnancy experiences, the film also features the stories of a few who, for various reasons, placed their children for adoption or continued to parent. While the filmmakers interview Alexis, a pregnant Black high school student whose mother died when she was 8 years old, classmates can be heard in the distance tormenting her, asking if she’s on the MTV reality show 16 and Pregnant. She’s visibly distraught and crying, illustrating the “damned if you do, damned if you don’t” conundrum women of color experiencing unintended pregnancy often face.

Te’Aundra, another young Black woman, shares her story of becoming pregnant just as she received a college basketball scholarship. She was forced to turn down the scholarship and sought an adoption, but the adoption agency refused to help her since the child’s father wouldn’t agree to it. She says she would have had an abortion if she could start over again.

While anti-choice rhetoric has conflated adoption as the automatic abortion alternative, research has shown that most seeking adoption are personally debating between adoption and parenting. This is illustrated in Janet’s story, a woman with a drug addiction who was raising one child with her partner, but wasn’t able to raise a second, so she sought an adoption. These stories are examples of the many societal systems failing those who choose adoption or students raising families, in addition to those fighting barriers to abortion access.

At times, the film feels repetitive and disjointed, but the stories are powerful. The range of experiences and reasons for having an abortion (or seeking adoption) bring to life the data points too often ignored by politicians and the media: everything from economic instability and fetal health, to domestic violence and desire to finish an education. The majority of abortion stories featured were shared by those who already had children. Their stories had a recurring theme of loneliness and lack of support from their loved ones and friends at a time when they needed it. Research has shown that 66 percent of people who have abortions tend to only tell 1.24 people about their experience, leaving them keeping a secret for fear of judgment and shame.

While many cite financial issues when paying for abortions or as the reason for not continuing the pregnancy, the film doesn’t go in depth about how the patients come to pay for their abortions—which is something my employer, the National Network for Abortion Funds (NNAF), directly addresses—or the systemic issues that created their financial situations.

However, it brings to light the hypocrisy of our nation, where the invisible hand of our society’s lack of respect for pregnant people and working parents can force people to make pregnancy decisions based on economic situations rather than a desire to be pregnant or parent.

“I’m not just doing this for me” is a common phrase when citing having an abortion for existing or future children.

Overall, the film is moving simply because abortion stories are moving, especially for audiences who don’t have the opportunity to have someone share their abortion story with them personally. I have been sharing my abortion story for five years and hearing someone share their story with me always feels like a gift. I heard parts of my own story in those shared; however, I felt underrepresented in this film that took place partly in my home state of Illinois. While people of color are present in the film in different capacities, a racial analysis around the issues covered in the film is non-existent.

Race is a huge factor when it comes to access to contraception and reproductive health care; over 60 percent of people who have abortions are people of color. Yet, it took 40 minutes for a person of color to share an abortion story. It seemed that five people of color’s abortion stories were shown out of the over 20 stories, but without actual demographic data, I cannot confirm how all the film’s storytellers identify racially. (HBO was not able to provide the demographic data of the storytellers featured in the film by press time.)

It’s true that racism mixed with sexism and abortion stigma make it more difficult for people of color to speak openly about their abortion stories, but continued lack of visual representation perpetuates that cycle. At a time when abortion storytellers themselves, like those of NNAF’s We Testify program, are trying to make more visible a multitude of identities based on race, sexuality, immigration status, ability, and economic status, it’s difficult to give a ringing endorsement of a film that minimizes our stories and relegates us to the second half of a film, or in the cases of some of these identities, nowhere at all. When will we become the central characters that reality and data show that we are?

In July, at the progressive conference Netroots Nation, the film was screened followed by an all-white panel discussion. I remember feeling frustrated at the time, both because of the lack of people of color on the panel and because I had planned on seeing the film before learning about a march led by activists from Hands Up United and the Organization for Black Struggle. There was a moment in which I felt like I had to choose between my Blackness and my abortion experience. I chose my Black womanhood and marched with local activists, who under the Black Lives Matter banner have centered intersectionality. My hope is that soon I won’t have to make these decisions in the fight for abortion rights; a fight where people of color are the backbone whether we’re featured prominently in films or not.

The film highlights the violent rhetoric anti-choice protesters use to demean those seeking abortions, but doesn’t dissect the deeply racist and abhorrent comments, often hurled at patients of color by older white protesters. These racist and sexist comments are what fuel much of the stigma that allows discriminatory laws, such as those banning so-called race- and sex-selective abortions, to flourish.

As I finished the documentary, I remembered a quote Chelsea, a white Christian woman who chose an abortion when her baby’s skull stopped developing above the eyes, said: “Knowing you’re not alone is the most important thing.”

In her case, her pastor supported her and her husband’s decision and prayed over them at the church. She seemed at peace with her decision to seek abortion because she had the support system she desired. Perhaps upon seeing the film, some will realize that all pregnancy decisions can be quite isolating and lonely, and we should show each other a bit more compassion when making them.

My hope is that the film reaches others who’ve had abortions and reminds them that they aren’t alone, whether they see themselves truly represented or not. That we who choose abortion are normal, loved, and supported. And that’s the main point of the film, isn’t it?

Abortion: Stories Women Tell is available in theaters in select cities and will be available on HBO in 2017.

News Abortion

Idaho Directs Pregnant People to Fake Clinics for Free Ultrasounds

Nicole Knight

The state health department doesn't screen the providers, which "gives the false impression that this is a vetted list …when it’s actually not," as Hannah Brass Greer, Idaho legislative director of Planned Parenthood Votes Northwest and Hawaii, told Rewire.

Idaho’s health department is now sending patients seeking abortion care to fake clinics, also known as crisis pregnancy centers, thanks to a new Republican-backed law promoting free ultrasound providers.

The law, HB 516, amends an existing statute to require the state Department of Health and Welfare to compile a list of providers of free ultrasounds. The agency must also let pregnant people know they have the “right to view an ultrasound image and hear heart tone monitoring.”

The health department, however, doesn’t screen the providers, which “gives the false impression that this is a vetted list …when it’s actually not,” as Hannah Brass Greer, Idaho legislative director of Planned Parenthood Votes Northwest and Hawaii, told Rewire.

Getting included on the list simply requires contacting the health department, and all of the 11 providers now on it are anti-abortion facilities. As Brandi Swindell, CEO of Stanton Healthcare, which has two clinics on the list, told the Associated Press, “I’m 100 percent pro-life.”

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When Rewire reached Sherry Bushnell at A Blessed Beginning, which is also included on the health department’s list, she said they actually don’t provide free ultrasounds right now because their ultrasound facility is “under construction.” She said they refer clients to Life Choices, in nearby Sandpoint, Idaho.

Like most anti-choice clinics, A Blessed Beginning espouses unscientific claims about the psychological risks of abortion care. Its website warns that abortion causes everything from eating disorders to suicidal thoughts, although peer-reviewed studies have found no link between abortion care and depressionanxiety, or post-traumatic stress disorder.

The health department issued the list August 1, and it includes facility names, addresses, contact information, and hours. One of the clinics is actually in Washington state, not Idaho. Planned Parenthood isn’t included because it does not offer free ultrasounds, though representatives from the organization told Rewire it does offer financial assistance to those in need.

Buried at the bottom of the four-page list is a small disclaimer that says, in part:

This information is not intended to constitute medical advice or the provision of medical services …. The Department of Health and Welfare does not inspect, certify, or endorse any of the providers listed and cannot be held liable for the action(s) of said providers.

“Adding that language was a way to let people know that we’re not saying this is going to be a great ultrasound experience,” health department spokesperson Niki Forbing-Orr told the Associated Press. “There’s no registry for this type of equipment in Idaho. Anyone can own and operate one.”

As Rewire previously reported, one of the clinics on the health department list is directly connected to Rep. Vito Barbieri (R-Dalton Gardens), who voted in favor of the legislation. In 2014, Barbieri was president of the board of directors of Open Arms PCC and Real Choices Clinic, which is included on the health department’s list.

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