Commentary Human Rights

Many International Agreements Later, Girls and Young Women Worldwide Still Lack Basic Rights

Louise Finer

Adolescents worldwide lack access to the sexuality education and the comprehensive sexual and reproductive health information and services that play a critical role in their well-being and empowerment. The implementation of the full range of reproductive rights — as fundamental human rights — must be a priority for all countries.

Moldova is one of more than two dozen countries that celebrate International Women’s Day — March 8 — as a holiday, with an official day off and a long-held tradition of showering women with gifts. But Moldova is also a country that continues to deprive women and girls of their full reproductive rights, evidenced in part by its refusal to make sexuality education in public schools mandatory and its failure to provide Moldovan women and girls with affordable and safe contraceptives.

This year, for International Women’s Day, the Center for Reproductive Rights is focusing its attention on girls and young women. Adolescents worldwide lack access to the sexuality education and the comprehensive sexual and reproductive health information and services that play a critical role in their well-being and empowerment. The implementation of the full range of reproductive rights — as fundamental human rights — must be a priority for all countries.

This reality is particularly disappointing given that the international Cairo Conference in 1994 that brought together 179 countries yielded the recognition that the reproductive health needs of adolescents up to that point had been largely ignored.

The Center for Reproductive Rights has long been at the forefront of advocating for access to reproductive health services for young women and girls. We brought two landmark cases on behalf of young women in Peru together with our local partners. In each, a United Nations committee of experts condemned the government for denying legal abortion services to these young women, who suffered tragic consequences as a result. (Read about K.L., a young woman forced to carry a pregnancy to term even though doctors had determined that continuing the pregnancy compromised her physical and mental health, and L.C., a 13-year-old rape victim who suffered irrevocable harm after doctors refused to terminate her pregnancy to enable her to immediately undergo a critical spinal surgery).

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In the U.S., we stopped a state policy that would have legalized an unheard of level of intrusion into the medical privacy of teenagers under the pretext of protecting them from child abuse. Kansas would have forced a host of health providers including doctors, school counselors and therapists to report the most innocuous of activities — like French-kissing between teens younger than 16 — to state agencies as possible child abuse. The policy would have made it impossible for teenagers to trust their health care providers.

We took these actions long after the 1994 Cairo conference called for governments to take action, during a period that has seen youth population figures soar. Today, nearly half the world is 24 years of age or younger — but the ability of young adults and adolescents to exercise their sexual and reproductive rights has not kept pace.

  • Every year, people aged 10 to 24 experience 111 million cases of sexually transmitted infections.
  • Sixty percent of people between the ages of 15 and 24 don’t know how to prevent the transmission of HIV.
  • Numerous countries, including India and Norway, violate adolescents’ rights to confidentiality and deter them from obtaining legal abortion services through parental consent or notification requirements.
  • In other countries, including Poland and parts of the U.S., sexuality education courses include content that is inappropriate and ideologically driven.

It’s time to revisit the promises made at the 1994 conference and recommit to making reproductive health and rights for young people a priority. The 45th session of the United Nations Commission on Population and Development presents the ideal opportunity to do so, when states gather in New York to discuss issues affecting adolescents and youth. The Center will be co-hosting a side event with International Planned Parenthood Federation to talk about autonomy, decision-making, confidentiality, and consent, which are crucial issues to adolescents’ ability to exercise their sexual and reproductive rights.

We certainly applaud any country that sees fit to pay tribute to girls and women with this special day. But we call on every country to truly honor them by respecting their human rights to reproductive health information and services, including comprehensive sexuality education. Only in this way can their dignity and welfare be safeguarded.

Commentary Sexual Health

Parents, Educators Can Support Pediatricians in Providing Comprehensive Sexuality Education

Nicole Cushman

While medical systems will need to evolve to address the challenges preventing pediatricians from sharing medically accurate and age-appropriate information about sexuality with their patients, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Last week, the American Academy of Pediatrics (AAP) released a clinical report outlining guidance for pediatricians on providing sexuality education to the children and adolescents in their care. As one of the most influential medical associations in the country, AAP brings, with this report, added weight to longstanding calls for comprehensive sex education.

The report offers guidance for clinicians on incorporating conversations about sexual and reproductive health into routine medical visits and summarizes the research supporting comprehensive sexuality education. It acknowledges the crucial role pediatricians play in supporting their patients’ healthy development, making them key stakeholders in the promotion of young people’s sexual health. Ultimately, the report could bolster efforts by parents and educators to increase access to comprehensive sexuality education and better equip young people to grow into sexually healthy adults.

But, while the guidance provides persuasive, evidence-backed encouragement for pediatricians to speak with parents and children and normalize sexual development, the report does not acknowledge some of the practical challenges to implementing such recommendations—for pediatricians as well as parents and school staff. Articulating these real-world challenges (and strategies for overcoming them) is essential to ensuring the report does not wind up yet another publication collecting proverbial dust on bookshelves.

The AAP report does lay the groundwork for pediatricians to initiate conversations including medically accurate and age-appropriate information about sexuality, and there is plenty in the guidelines to be enthusiastic about. Specifically, the report acknowledges something sexuality educators have long known—that a simple anatomy lesson is not sufficient. According to the AAP, sexuality education should address interpersonal relationships, body image, sexual orientation, gender identity, and reproductive rights as part of a comprehensive conversation about sexual health.

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The report further acknowledges that young people with disabilities, chronic health conditions, and other special needs also need age- and developmentally appropriate sex education, and it suggests resources for providing care to LGBTQ young people. Importantly, the AAP rejects abstinence-only approaches as ineffective and endorses comprehensive sexuality education.

It is clear that such guidance is sorely needed. Previous studies have shown that pediatricians have not been successful at having conversations with their patients about sexuality. One study found that one in three adolescents did not receive any information about sexuality from their pediatrician during health maintenance visits, and those conversations that did occur lasted less than 40 seconds, on average. Another analysis showed that, among sexually experienced adolescents, only a quarter of girls and one-fifth of boys had received information from a health-care provider about sexually transmitted infections or HIV in the last year. 

There are a number of factors at play preventing pediatricians from having these conversations. Beyond parental pushback and anti-choice resistance to comprehensive sex education, which Martha Kempner has covered in depth for Rewire, doctor visits are often limited in time and are not usually scheduled to allow for the kind of discussion needed to build a doctor-patient relationship that would be conducive to providing sexuality education. Doctors also may not get needed in-depth training to initiate and sustain these important, ongoing conversations with patients and their families.

The report notes that children and adolescents prefer a pediatrician who is nonjudgmental and comfortable discussing sexuality, answering questions and addressing concerns, but these interpersonal skills must be developed and honed through clinical training and practice. In order to fully implement the AAP’s recommendations, medical school curricula and residency training programs would need to devote time to building new doctors’ comfort with issues surrounding sexuality, interpersonal skills for navigating tough conversations, and knowledge and skills necessary for providing LGBTQ-friendly care.

As AAP explains in the report, sex education should come from many sources—schools, communities, medical offices, and homes. It lays out what can be a powerful partnership between parents, doctors, and educators in providing the age-appropriate and truly comprehensive sexuality education that young people need and deserve. While medical systems will need to evolve to address the challenges outlined above, there are several things I recommend parents and educators do to reinforce AAP’s guidance.

Parents and Caregivers: 

  • When selecting a pediatrician for your child, ask potential doctors about their approach to sexuality education. Make sure your doctor knows that you want your child to receive comprehensive, medically accurate information about a range of issues pertaining to sexuality and sexual health.
  • Talk with your child at home about sex and sexuality. Before a doctor’s visit, help your child prepare by encouraging them to think about any questions they may have for the doctor about their body, sexual feelings, or personal safety. After the visit, check in with your child to make sure their questions were answered.
  • Find out how your child’s school approaches sexuality education. Make sure school administrators, teachers, and school board members know that you support age-appropriate, comprehensive sex education that will complement the information provided by you and your child’s pediatrician.

School Staff and Educators: 

  • Maintain a referral list of pediatricians for parents to consult. When screening doctors for inclusion on the list, ask them how they approach sexuality education with patients and their families.
  • Involve supportive pediatricians in sex education curriculum review committees. Medical professionals can provide important perspective on what constitutes medically accurate, age- and developmentally-appropriate content when selecting or adapting curriculum materials for sex education classes.
  • Adopt sex-education policies and curricula that are comprehensive and inclusive of all young people, regardless of sexual orientation or gender identity. Ensure that teachers receive the training and support they need to provide high-quality sex education to their students.

The AAP clinical report provides an important step toward ensuring that young people receive sexuality education that supports their healthy sexual development. If adopted widely by pediatricians—in partnership with parents and schools—the report’s recommendations could contribute to a sea change in providing young people with the care and support they need.

News Politics

Sen. Tim Kaine Focuses on Reproductive Rights Amid Clinton’s Looming Decision on Vice President

Ally Boguhn

Last week, the senator and former Virginia governor argued in favor of giving Planned Parenthood access to funding in order to fight Zika. "The uniform focus for members of Congress should be, 'Let's solve the problem,'" Kaine reportedly said at a meeting in Richmond, according to Roll Call.

Sen. Tim Kaine (D-VA) appears to be rebranding himself as a more staunch pro-choice advocate after news that the senator was one of at least three potential candidates being vetted by presumptive Democratic nominee Hillary Clinton’s campaign to join her presidential ticket.

Last week, the senator and former Virginia governor argued in favor of giving Planned Parenthood access to funding in order to fight the Zika virus. “The uniform focus for members of Congress should be, ‘Let’s solve the problem,'” Kaine reportedly said at a meeting in Richmond, according to Roll Call. “That is [the] challenge right now between the Senate and House.”

Kaine went on to add that “Planned Parenthood is a primary health provider. This is really at the core of dealing with the population that has been most at risk of Zika,” he continued.

As Laura Bassett and Ryan Grim reported for the Huffington Post Tuesday, “now that Clinton … is vetting him for vice president, Kaine needs to bring his record more in line with hers” when it comes to reproductive rights. While on the campaign trail this election cycle, Clinton has repeatedly spoken out against restrictions on abortion access and funding—though she has stated that she still supports some restrictions, such as a ban on later abortions, as long as they have exceptions.

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In what is seemingly an effort to address the issue, as Bassett and Grim suggested, Kaine signed on last week as a co-sponsor of the Women’s Health Protection Act, which would prohibit states and the federal government from enacting restrictions on abortion that aren’t applied to comparable medical services. As previously reported by Rewire, the measure would effectively stop “TRAP (targeted regulation of abortion provider) laws, forced ultrasounds, waiting periods, or restrictions on medication abortion.” TRAP laws have led to unprecedented barriers in access to abortion care.

Just one day before endorsing the legislation, Kaine issued a statement explicitly expressing his support for abortion rights after the Supreme Court struck down two provisions of Texas’ omnibus anti-choice law HB 2.

“I applaud the Supreme Court for seeing the Texas law for what it is—an attempt to effectively ban abortion and undermine a woman’s right to make her own health care choices,” said Kaine in the press release. “This ruling is a major win for women and families across the country, as well as the fight to expand reproductive freedom for all.”

The Virginia senator went on to use the opportunity to frame himself as a defender of those rights during his tenure as governor of his state. “The Texas law is quite similar to arbitrary and unnecessary rules that were imposed on Virginia women after I left office as Governor,” said Kaine. “I’m proud that we were able to successfully fight off such ‘TRAP’ regulations during my time in state office. I have always believed these sort of rules are an unwarranted effort to deprive women of their constitutionally protected right to terminate a pregnancy.”

Kaine also spoke out during his run for the Senate in 2012 when then-Gov. Bob McDonnell (R) signed a law requiring those who seek abortions to undergo an ultrasound prior to receiving care, calling the law “bad for Virginia’s image, bad for Virginia’s businesses and bad for Virginia’s women.”

Kaine’s record on abortion has of late been a hot topic among those speculating he could be a contender for vice president on the Clinton ticket. While Kaine’s website says that he “support[s] the right of women to make their own health and reproductive decisions” and that he opposes efforts to overturn Roe v. Wade, the senator recently spoke out about his personal opposition to abortion.

When host Chuck Todd asked Kaine during a recent interview on NBC’s Meet the Press about Kaine previously being “classified as a pro-life Democrat” while lieutenant governor of Virginia, Kaine described himself as a “traditional Catholic” who is “opposed to abortion.”

Kaine went on to affirm that he nonetheless still believed that the government should not intrude on the matter. “I deeply believe, and not just as a matter of politics, but even as a matter of morality, that matters about reproduction and intimacy and relationships and contraception are in the personal realm,” Kaine continued. “They’re moral decisions for individuals to make for themselves. And the last thing we need is government intruding into those personal decisions.”

As the Hill noted in a profile on Kaine’s abortion stance, as a senator Kaine has “a 100 percent rating from Planned Parenthood’s scorecard, and has consistently voted against measures like defunding Planned Parenthood and a ban on abortions after the 20th week of pregnancy.”

While running for governor of Virginia in 2005, however, Kaine promised that if elected he would “work in good faith to reduce abortions” by enforcing Virginia’s “restrictions on abortion and passing an enforceable ban on partial birth abortion that protects the life and health of the mother.”

After taking office, Kaine supported some existing restrictions on abortion, such as Virginia’s parental consent law and a so-called informed consent law, which in 2008 he claimed gave “women information about a whole series of things, the health consequences, et cetera, and information about adoption.” In truth, the information such laws mandate giving out is often “irrelevant or misleading,” according to the the Guttmacher Institute.

In 2009 he also signed a measure that allowed the state to create “Choose Life” license plates and give a percentage of the proceeds to a crisis pregnancy network, though such organizations routinely lie to women to persuade them not to have an abortion.