News Race

Groundbreaking Bill Integrates Pregnancy and Violence Prevention Strategies for Young People of Color

Rebecca Medina

Today a groundbreaking bill was introduced in Congress with a first-ever policy approach that combines teen dating violence prevention and teen pregnancy prevention in communities of color.

While the rest of the policy world is going a bit crazy arguing about the debt ceiling or trying to restrict women’s reproductive health access, how about a bit of good news for young women?  Today a groundbreaking bill was introduced in Congress with a first-ever policy approach that combines teen dating violence prevention and teen pregnancy prevention in communities of color.

The “Communities of Color Teenage Pregnancy Prevention Act,” HR 2678, recognizes that a broader approach is needed to address teen pregnancy in communities of color, including the role coercion and violence plays in unintended pregnancy, and invests in getting young people of color the information and skills they need to build healthy relationships.  It further addresses the need among racial or ethnic minority and immigrant communities for culturally appropriate information and education on issues of reproductive and sexual health.

The bill will be introduced today by U.S. Representative and Chairwoman of the Congressional Hispanic Caucus Health Task Force, Lucille Roybal-Allard (D-CA), and Senator Barbara Boxer (D-CA). Both are long-time champions of efforts to reduce health disparities and violence among Latinos and other ethnic communities.  

Young women of color in general, and particularly immigrant young women, often experience a multitude of barriers to essential health care and information  and this bill is a good start in providing new resources.  

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In 2009 the teen birth rate for Latinas, African Americans and American Indians/Alaska Natives was more than double the teen birth rate of non-Hispanic Caucasians. However, disparities in contraceptive use are closely connected to social and economic inequities in communities of color; for example, a Latina girl is three times more likely to be without health insurance than her white counterpart.  

Dating violence is a growing crisis among our teens: 1 in 4 adolescents reporting emotional, physical, or sexual violence each year.  Teens in abusive relationships are at significantly higher risk for unintended pregnancy, poor pregnancy outcomes, and sexually transmitted infections, including HIV.   Adolescent girls in physically abusive relationships are three times more likely to become pregnant than non-abused girls. 

These can be reduced if we give young people more resources to recognize, avoid, or get out of unhealthy relationships.

Not only is the bill unique in its integrated approach to pregnancy prevention, but it also recognizes the need to help teens develop healthy relationships.  The Communities of Color Teenage Pregnancy Prevention Act would:

  • fund demonstration projects for new and existing teenage pregnancy prevention program interventions with a focus on supporting community-based organizations that are well-positioned to serve youth in ethnic and racial groups with the highest teen pregnancy rates;
  • fund multimedia public education and awareness about teen pregnancy and related social and emotional issues, such as violence prevention;

  • study factors that contribute to disproportionately high rates of teenage and unintended pregnancy in communities of color, and the role that violence and abuse play in the decisions young people make about relationships, sex, pregnancy, and childbearing.

The legislation has been advocated by the National Latina Institute for Reproductive Health, Futures Without Violence (formerly the Family Violence Prevention Fund), and The National Campaign to Prevent Teen and Unplanned Pregnancy .   

This groundbreaking legislation will give our young people support to build healthy relationships and improve their overall health and well-being.

Commentary Contraception

The Promotion of Long-Acting Contraceptives Must Confront History and Center Patient Autonomy

Jamila Taylor

While some long-acting reversible contraceptive methods were used to undermine women of color's reproductive freedom, those methods still hold the promise of reducing unintended pregnancy among those most at risk.

Since long-acting reversible contraceptives (LARCs), including intrauterine devices and hormonal contraceptive implants, are among the most effective means of pregnancy prevention, many family planning and reproductive health providers are increasingly promoting them, especially among low-income populations.

But the promotion of LARCs must come with an acknowledgment of historical discriminatory practices and public policy related to birth control. To improve contraceptive access for low-income women and girls of color—who bear the disproportionate effects of unplanned pregnancy—providers and advocates must work to ensure that the reproductive autonomy of this population is respected now, precisely because it hasn’t been in the past.

For Black women particularly, the reproductive coercion that began during slavery took a different form with the development of modern contraceptive methods. According to Dorothy Roberts, author of Killing the Black Body, “The movement to expand women’s reproductive options was marked with racism from its very inception in the early part of [the 20th] century.” Decades later, government-funded family planning programs encouraged Black women to use birth control; in some cases, Black women were coerced into being sterilized.

In the 1990s, the contraceptive implant Norplant was marketed specifically to low-income women, especially Black adults and teenage girls. After a series of public statements about the benefits of Norplant in reducing pregnancy among this population, policy proposals soon focused on ensuring usage of the contraceptive method. Federal and state governments began paying for Norplant and incentivizing its use among low-income women while budgets for social support programs were cut. Without assistance, Norplant was not an affordable option, with the capsules costing more than $300 and separate, expensive costs for implantation and removal.

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Soon, Norplant was available through the Medicaid program. Some states introduced (ultimately unsuccessful) bills that would give cash rewards to entice low-income women on public assistance into using it; a few, such as Tennessee and Washington state, required that women receiving various forms of public assistance get information about Norplant. After proposing a bill to promote the use of Norplant in his state in 1994, a Connecticut legislator made the comment, “It’s far cheaper to give you money not to have kids than to give you money to have kids.” By that year, as Roberts writes, states had spent $34 million on Norplant-related care, much of it for women on Medicaid. Policymakers thought it was completely legitimate and cost-effective to control the reproduction of low-income women.

However, promoting this method among low-income Black women and adolescents was problematic. Racist, classist ideology dictating that this particular population of women shouldn’t have children became the basis for public policy. Even though coercive practices in reproductive health were later condemned, these practices still went on to shape cultural norms around race and gender, as well as medical practice.

This history has made it difficult to move beyond negative perceptions, and even fear, of LARCs, health care, and the medical establishment among some women of color. And that’s why it’s so important to ensure informed consent when advocating for effective contraceptive methods, with choice always at the center.

But how can policies and health-care facilities promote reproductive autonomy?

Health-care providers must deal head on with the fact that many contemporary women have concerns about LARCs being recommended specifically to low-income women and women of color. And while this is part of the broader effort to make LARCs more affordable and increasingly available to communities that don’t have access to them, mechanisms should be put in place to address this underlying issue. Requiring cultural competency training that includes information on the history of coercive practices affecting women of color could help family planning providers understand this concern for their patients.

Then, providers and health systems must address other barriers that make it difficult for women to access LARCs in particular. LARCs can be expensive in the short term, and complicated billing and reimbursement practices in both public and private insurance confuse women and providers. Also, the full cost associated with LARC usage isn’t always covered by insurance.

But the process shouldn’t end at eliminating barriers. Low-income Black women and teens must receive comprehensive counseling for contraception to ensure informed choice—meaning they should be given information on the full array of methods. This will help them choose the method that best meets their needs, while also promoting reproductive autonomy—not a specific contraceptive method.

Clinical guidelines for contraception must include detailed information on informed consent, and choice and reproductive autonomy should be clearly outlined when family planning providers are trained.

It’s crucial we implement these changes now because recent investments and advocacy are expanding access to LARCs. States are thinking creatively about how to reduce unintended pregnancy and in turn reduce Medicaid costs through use of LARCs. The Colorado Family Planning Initiative has been heralded as one of the most effective in helping women access LARCs. Since 2008, more than 30,000 women in Colorado have chosen LARCs as the result of the program. Provider education, training, and contraceptive counseling have also been increased, and women can access LARCs at reduced costs.

The commitment to LARCs has apparently yielded major returns for Colorado. Between 2009 and 2013, the abortion rate among teenagers older than 15 in Colorado dropped by 42 percent. Additionally, the birth rate for young women eligible for Medicaid dropped—resulting in cost savings of up to an estimated $111 million in Medicaid-covered births. LARCs have been critical to these successes. Public-private partnerships have helped keep the program going since 2015, and states including Delaware and Iowa have followed suit in efforts to experience the same outcomes.

Recognizing that prevention is a key component to any strategy addressing a public health concern, those strategies must be rooted in ensuring access to education and comprehensive counseling so that women and teens can make the informed choices that are best for them. When women and girls are given the tools to empower themselves in decision making, the results are positive—not just for what the government spends or does not spend on social programs, but also for the greater good of all of us.

The history of coercion undermining reproductive freedom among women and girls of color in this country is an ugly one. But this certainly doesn’t have to dictate how we move forward.

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.

 

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