Commentary Contraception

Want To Help Make History Demanding Female Condoms?

Anna Forbes

Have you ever been part of an attempt to set a new record in the Guinness Book of World Records?  Want to help break an existing world record while also helping to increase access to HIV prevention tools?  If so, YOUR MESSAGE can be featured in what we hope will become the world’s longest chain of paper dolls. It will be on display as at the International AIDS Conference in Washington DC this July.

Have you ever been part of an attempt to set a new record in the Guinness Book of World Records?  Want to help break an existing world record while also helping to increase access to HIV prevention tools?  If so, YOUR MESSAGE can be featured in what we hope will become the world’s longest chain of paper dolls. It will be on display as at the International AIDS Conference in Washington DC this July.

Universal Access to Female Condoms (UAFC) is working in partnership with CHANGE, Rewire and dozens of other organizations around the world to collect 30,000 individually completed Paper Dolls to display in one massive chain at the conference. This extraordinary visual statement will illustrate the broad-based, urgent demand for female condoms that exists all around the world. Right now, only 1% of all condoms used worldwide are female condoms (FC). Most people either don’t know about FCs or have never used them because they are poorly promoted, expensive and/or unavailable to them. Meanwhile, over half of all people living with HIV worldwide are women.  Female condoms are just as effective as male condoms in preventing HIV and pregnancy—and they allow women to protect themselves when male condoms aren’t being used. 

On Facebook, you can learn more about this project. To participate, just go to sign4femalecondons.org and put your own message on a paper doll.  UAFC will print your message out on a doll. Then your doll will be in the added to the chain, and help us to break the world record on July 27, 2012. Participation is free, it’s fast and you will contribute to a powerful visual statement to urge policy-makers and funders to invest more in making this under-utilized, highly effective HIV prevention tool accessible to all women and men who need them.

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Analysis Abortion

‘Pro-Life’ Pence Transfers Money Intended for Vulnerable Households to Anti-Choice Crisis Pregnancy Centers

Jenn Stanley

Donald Trump's running mate has said that "life is winning in Indiana"—and the biggest winner is probably a chain of crisis pregnancy centers that landed a $3.5 million contract in funds originally intended for poor Hoosiers.

Much has been made of Republican Gov. Mike Pence’s record on LGBTQ issues. In 2000, when he was running for U.S. representative, Pence wrote that “Congress should oppose any effort to recognize homosexual’s [sic] as a ‘discreet and insular minority’ [sic] entitled to the protection of anti-discrimination laws similar to those extended to women and ethnic minorities.” He also said that funds meant to help people living with HIV or AIDS should no longer be given to organizations that provide HIV prevention services because they “celebrate and encourage” homosexual activity. Instead, he proposed redirecting those funds to anti-LGBTQ “conversion therapy” programs, which have been widely discredited by the medical community as being ineffective and dangerous.

Under Pence, ideology has replaced evidence in many areas of public life. In fact, Republican presidential nominee Donald Trump has just hired a running mate who, in the past year, has reallocated millions of dollars in public funds intended to provide food and health care for needy families to anti-choice crisis pregnancy centers.

Gov. Pence, who declined multiple requests for an interview with Rewire, has been outspoken about his anti-choice agenda. Currently, Indiana law requires people seeking abortions to receive in-person “counseling” and written information from a physician or other health-care provider 18 hours before the abortion begins. And thanks, in part, to other restrictive laws making it more difficult for clinics to operate, there are currently six abortion providers in Indiana, and none in the northern part of the state. Only four of Indiana’s 92 counties have an abortion provider. All this means that many people in need of abortion care are forced to take significant time off work, arrange child care, and possibly pay for a place to stay overnight in order to obtain it.

This environment is why a contract quietly signed by Pence last fall with the crisis pregnancy center umbrella organization Real Alternatives is so potentially dangerous for Indiana residents seeking abortion: State-subsidized crisis pregnancy centers not only don’t provide abortion but seek to persuade people out of seeking abortion, thus limiting their options.

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“Indiana is committed to the health, safety, and wellbeing [sic] of Hoosier families, women, and children,” reads the first line of the contract between the Indiana State Department of Health and Real Alternatives. The contract, which began on October 1, 2015, allocates $3.5 million over the course of a year for Real Alternatives to use to fund crisis pregnancy centers throughout the state.

Where Funding Comes From

The money for the Real Alternatives contract comes from Indiana’s Temporary Assistance for Needy Families (TANF) block grant, a federally funded, state-run program meant to support the most vulnerable households with children. The program was created by the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by former President Bill Clinton. It changed welfare from a federal program that gave money directly to needy families to one that gave money, and a lot of flexibility with how to use it, to the states.

This TANF block grant is supposed to provide low-income families a monthly cash stipend that can be used for rent, child care, and food. But states have wide discretion over these funds: In general, they must use the money to serve families with children, but they can also fund programs meant, for example, to promote marriage. They can also make changes to the requirements for fund eligibility.

As of 2012, to be eligible for cash assistance in Indiana, a household’s maximum monthly earnings could not exceed $377, the fourth-lowest level of qualification of all 50 states, according to a report by the Congressional Research Service. Indiana’s program also has some of the lowest maximum payouts to recipients in the country.

Part of this is due to a 2011 work requirement that stripped eligibility from many families. Under the new work requirement, a parent or caretaker receiving assistance needs to be “engaged in work once the State determines the parent or caretaker is ready to engage in work,” or after 24 months of receiving benefits. The maximum time allowed federally for a family to receive assistance is 60 months.

“There was a TANF policy change effective November 2011 that required an up-front job search to be completed at the point of application before we would proceed in authorizing TANF benefits,” Jim Gavin, a spokesman for the state’s Family and Social Services Administration (FSSA), told Rewire. “Most [applicants] did not complete the required job search and thus applications were denied.”

Unspent money from the block grant can be carried over to following years. Indiana receives an annual block grant of $206,799,109, but the state hasn’t been using all of it thanks to those low payouts and strict eligibility requirements. The budget for the Real Alternatives contract comes from these carry-over funds.

According to the U.S. Department of Health and Human Services, TANF is explicitly meant to clothe and feed children, or to create programs that help prevent “non-marital childbearing,” and Indiana’s contract with Real Alternatives does neither. The contract stipulates that Real Alternatives and its subcontractors must “actively promote childbirth instead of abortion.” The funds, the contract says, cannot be used for organizations that will refer clients to abortion providers or promote contraceptives as a way to avoid unplanned pregnancies and sexually transmitted infections.

Parties involved in the contract defended it to Rewire by saying they provide material goods to expecting and new parents, but Rewire obtained documents that showed a much different reality.

Real Alternatives is an anti-choice organization run by Kevin Bagatta, a Pennsylvania lawyer who has no known professional experience with medical or mental health services. It helps open, finance, and refer clients to crisis pregnancy centers. The program started in Pennsylvania, where it received a $30 million, five-year grant to support a network of 40 subcontracting crisis pregnancy centers. Auditor General Eugene DePasquale called for an audit of the organization between June 2012 and June 2015 after hearing reports of mismanaged funds, and found $485,000 in inappropriate billing. According to the audit, Real Alternatives would not permit DHS to review how the organization used those funds. However, the Pittsburgh Post-Gazette reported in April that at least some of the money appears to have been designated for programs outside the state.

Real Alternatives also received an $800,000 contract in Michigan, which inspired Gov. Pence to fund a $1 million yearlong pilot program in northern Indiana in the fall of 2014.

“The widespread success [of the pilot program] and large demand for these services led to the statewide expansion of the program,” reads the current $3.5 million contract. It is unclear what measures the state used to define “success.”

 

“Every Other Baby … Starts With Women’s Care Center”

Real Alternatives has 18 subcontracting centers in Indiana; 15 of them are owned by Women’s Care Center, a chain of crisis pregnancy centers. According to its website, Women’s Care Center serves 25,000 women annually in 23 centers throughout Florida, Illinois, Indiana, Michigan, Minnesota, Ohio, and Wisconsin.

Women’s Care Centers in Indiana received 18 percent of their operating budget from state’s Real Alternatives program during the pilot year, October 1, 2014 through September 30, 2015, which were mostly reimbursements for counseling and classes throughout pregnancy, rather than goods and services for new parents.

In fact, instead of the dispensation of diapers and food, “the primary purpose of the [Real Alternatives] program is to provide core services consisting of information, sharing education, and counseling that promotes childbirth and assists pregnant women in their decision regarding adoption or parenting,” the most recent contract reads.

The program’s reimbursement system prioritizes these anti-choice classes and counseling sessions: The more they bill for, the more likely they are to get more funding and thus open more clinics.

“This performance driven [sic] reimbursement system rewards vendor service providers who take their program reimbursement and reinvest in their services by opening more centers and hiring more counselors to serve more women in need,” reads the contract.

Classes, which are billed as chastity classes, parenting classes, pregnancy classes, and childbirth classes, are reimbursed at $21.80 per client. Meanwhile, as per the most recent contract, counseling sessions, which are separate from the classes, are reimbursed by the state at minimum rates of $1.09 per minute.

Jenny Hunsberger, vice president of Women’s Care Center, told Rewire that half of all pregnant women in Elkhart, LaPorte, Marshall, and St. Joseph Counties, and one in four pregnant women in Allen County, are clients of their centers. To receive any material goods, such as diapers, food, and clothing, she said, all clients must receive this counseling, at no cost to them. Such counseling is billed by the minute for reimbursement.

“When every other baby born [in those counties] starts with Women’s Care Center, that’s a lot of minutes,” Hunsberger told Rewire.

Rewire was unable to verify exactly what is said in those counseling sessions, except that they are meant to encourage clients to carry their pregnancies to term and to help them decide between adoption or child rearing, according to Hunsberger. As mandated by the contract, both counseling and classes must “provide abstinence education as the best and only method of avoiding unplanned pregnancies and sexually transmitted infections.”

In the first quarter of the new contract alone, Women’s Care Center billed Real Alternatives and, in turn, the state, $239,290.97; about $150,000 of that was for counseling, according to documents obtained by Rewire. In contrast, goods like food, diapers, and other essentials for new parents made up only about 18.5 percent of Women’s Care Center’s first-quarter reimbursements.

Despite the fact that the state is paying for counseling at Women’s Care Center, Rewire was unable to find any licensing for counselors affiliated with the centers. Hunsberger told Rewire that counseling assistants and counselors complete a minimum training of 200 hours overseen by a master’s level counselor, but the counselors and assistants do not all have social work or psychology degrees. Hunsberger wrote in an email to Rewire that “a typical Women’s Care Center is staffed with one or more highly skilled counselors, MSW or equivalent.”

Rewire followed up for more information regarding what “typical” or “equivalent” meant, but Hunsberger declined to answer. A search for licenses for the known counselors at Women’s Care Center’s Indiana locations turned up nothing. The Indiana State Department of Health told Rewire that it does not monitor or regulate the staff at Real Alternatives’ subcontractors, and both Women’s Care Center and Real Alternatives were uncooperative when asked for more information regarding their counseling staff and training.

Bethany Christian Services and Heartline Pregnancy Center, Real Alternatives’ other Indiana subcontractors, billed the program $380.41 and $404.39 respectively in the first quarter. They billed only for counseling sessions, and not goods or classes.

In a 2011 interview with Philadelphia City Paper, Kevin Bagatta said that Real Alternatives counselors were not required to have a degree.

“We don’t provide medical services. We provide human services,” Bagatta told the City Paper.

There are pregnancy centers in Indiana that provide a full range of referrals for reproductive health care, including for STI testing and abortion. However, they are not eligible for reimbursement under the Real Alternatives contract because they do not maintain an anti-choice mission.

Parker Dockray is the executive director of Backline, an all-options pregnancy resource center. She told Rewire that Backline serves hundreds of Indiana residents each month, and is overwhelmed by demand for diapers and other goods, but it is ineligible for the funding because it will refer women to abortion providers if they choose not to carry a pregnancy to term.

“At a time when so many Hoosier families are struggling to make ends meet, it is irresponsible for the state to divert funds intended to support low-income women and children and give it to organizations that provide biased pregnancy counseling,” Dockray told Rewire. “We wish that Indiana would use this funding to truly support families by providing job training, child care, and other safety net services, rather than using it to promote an anti-abortion agenda.”

“Life Is Winning in Indiana”

Time and again, Bagatta and Hunsberger stressed to Rewire that their organizations do not employ deceitful tactics to get women in the door and to convince them not to have abortions. However, multiple studies have proven that crisis pregnancy centers often lie to women from the moment they search online for an abortion provider through the end of their appointments inside the center.

These studies have also shown that publicly funded crisis pregnancy centers dispense medically inaccurate information to clients. In addition to spreading lies like abortion causing infertility or breast cancer, they are known to give false hopes of miscarriages to people who are pregnant and don’t want to be. A 2015 report by NARAL Pro-Choice America found this practice to be ubiquitous in centers throughout the United States, and Rewire found that Women’s Care Center is no exception. The organization’s website says that as many as 40 percent of pregnancies end in natural miscarriage. While early pregnancy loss is common, it occurs in about 10 percent of known pregnancies, according to the American Congress of Obstetricians and Gynecologists.

Crisis pregnancy centers also tend to crop up next to abortion clinics with flashy, deceitful signs that lead many to mistakenly walk into the wrong building. Once inside, clients are encouraged not to have an abortion.

A Google search for “abortion” and “Indianapolis” turns up an ad for the Women’s Care Center as the first result. It reads: “Abortion – Indianapolis – Free Ultrasound before Abortion. Located on 86th and Georgetown. We’re Here to Help – Call Us Today: Abortion, Ultrasound, Locations, Pregnancy.”

Hunsberger denies any deceit on the part of Women’s Care Center.

“Clients who walk in the wrong door are informed that we are not the abortion clinic and that we do not provide abortions,” Hunsberger told Rewire. “Often a woman will choose to stay or return because we provide services that she feels will help her make the best decision for her, including free medical-grade pregnancy tests and ultrasounds which help determine viability and gestational age.”

Planned Parenthood of Indiana and Kentucky told Rewire that since Women’s Care Center opened on 86th and Georgetown in Indianapolis, many patients looking for its Georgetown Health Center have walked through the “wrong door.”

“We have had patients miss appointments because they went into their building and were kept there so long they missed their scheduled time,” Judi Morrison, vice president of marketing and education, told Rewire.

Sarah Bardol, director of Women’s Care Center’s Indianapolis clinic, told the Criterion Online Edition, a publication of the Archdiocese of Indianapolis, that the first day the center was open, a woman and her boyfriend did walk into the “wrong door” hoping to have an abortion.

“The staff of the new Women’s Care Center in Indianapolis, located just yards from the largest abortion provider in the state, hopes for many such ‘wrong-door’ incidents as they seek to help women choose life for their unborn babies,” reported the Criterion Online Edition.

If they submit to counseling, Hoosiers who walk into the “wrong door” and “choose life” can receive up to about $40 in goods over the course their pregnancy and the first year of that child’s life. Perhaps several years ago they may have been eligible for Temporary Assistance for Needy Families, but now with the work requirement, they may not qualify.

In a February 2016 interview with National Right to Life, one of the nation’s most prominent anti-choice groups, Gov. Pence said, “Life is winning in Indiana.” Though Pence was referring to the Real Alternatives contract, and the wave of anti-choice legislation sweeping through the state, it’s not clear what “life is winning” actually means. The state’s opioid epidemic claimed 1,172 lives in 2014, a statistically significant increase from the previous year, according to the Centers for Disease Control and Prevention. HIV infections have spread dramatically throughout the state, in part because of Pence’s unwillingness to support medically sound prevention practices. Indiana’s infant mortality rate is above the national average, and infant mortality among Black babies is even higher. And Pence has reduced access to prevention services such as those offered by Planned Parenthood through budget cuts and unnecessary regulations—while increasing spending on anti-choice crisis pregnancy centers.

Gov. Pence’s track record shows that these policies are no mistake. The medical and financial needs of his most vulnerable constituents have taken a backseat to religious ideology throughout his time in office. He has literally reallocated money for poor Hoosiers to fund anti-choice organizations. In his tenure as both a congressman and a governor, he’s proven that whether on a national or state level, he’s willing to put “pro-life” over quality-of-life for his constituents.

Commentary Sexual Health

It Shouldn’t Take a Chlamydia ‘Epidemic’ in Texas to Make Us Care About Teens’ Sexual Health

Martha Kempner

It was an outrageous—and ultimately false—story of 20 teens in a small high school in Texas having chlamydia that finally got media outlets to discuss whether kids need medically accurate information.

In recent weeks, numerous media reports have questioned whether abstinence-only-until-marriage programs are failing our high school students and leaving them vulnerable to sexually transmitted infections (STIs) and unintended pregnancies. Interestingly, it was not new statistics from the Centers for Disease Control and Prevention (CDC) showing the record high number of STIs among teens across the country, nor was it the mountains of research showing abstinence-only programs don’t work that made news. It wasn’t even the increased funding that Congress quietly passed for these failing programs last month that put this type of sex education in the spotlight. Instead, it was an outrageous—and ultimately false—story of 20 teens in a small high school in Texas having chlamydia that got media outlets, including the Washington Post, the U.S. News and World Report, People.com, and The View, to discuss whether kids need medically accurate information.

I appreciate the attention on this issue, and I hope the debate can go on even as we begin to learn the truth about what’s happening in Crane, Texas. But I am disappointed that yet again, the mainstream media and general public seem only to pay attention to teens’ sexual health needs when we can tie them to a situation so alarming or scandalous it can practically write its own headline.

This story began in early May, when the superintendent of the Crane Independent School District, Jim Rumage, sent a letter to parents alerting them that chlamydia was “on the rise” in the local high school. According to reports, the letter said that about 20 students out of the 300 in the school had tested positive for this bacterial STI. The article that ran on a local news website said that the CDC had declared this to be “epidemic proportions.” Rumage told reporters, “We do have an abstinence curriculum, and that’s evidently ain’t working. [sic] We need to do all we can, although it’s the parents’ responsibility to educate their kids on sexual education.”

From there the story took off, with articles and television pieces across the country and even internationally questioning how so many students could have an STI. (Rewire covered it in a podcast.) Most, like Rumage himself, ended up blaming the school’s poor sex education. Raw Story, for example, scoured the district’s website and pointed out that although the school does not offer a human sexuality course, it does run an optional three-day program that focuses on remaining abstinent until marriage. That story also noted that in 2012, an advisory panel recommended that the school adopt Worth the Wait, an abstinence curriculum produced by Scott and White Hospital in Texas that relies on fear and shame and suggests condoms provide very little protection from STIs.  

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This is not out of the ordinary for Texas, which has a long history of abstinence-only programs. When former President George W. Bush was governor, he started the Lone Star Leaders, one of the first state programs promoting abstinence until marriage. According to the Sexuality Information and Education Council of the United States (SIECUS), Texas has spent a total of $156 million in state and local funds on abstinence-only programs since 2003. And in March, the Texas House of Representatives voted to cut $3 million of funds currently allocated for HIV and STI prevention and devote them instead to abstinence-only programs, despite the fact that their state has the third-highest rate of HIV diagnoses in the country.

Though much of this abstinence funding is used outside of schools, Texas schools do often take a similar approach to sexuality education. State law does not mandate any sexuality education, but does say that it must focus on abstinence if it is taught. Though schools can discuss contraception and STIs, the law says that class must “devote more attention to abstinence from sexual activity than to any other behavior.” Moreover, the laws says that courses must “emphasize that abstinence from sexual activity, if used consistently and correctly, is the only method that is 100 percent effective in preventing pregnancy, sexually transmitted diseases (STDs), infection with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome.”

It appears that superintendent Rumage agrees with this aspect of the law. He told a local paper: “If kids are not having any sexual activity, they can’t get this disease … That’s not a bad program.”

I suppose he’s not entirely wrong. If his students weren’t having sex, they could not get chlamydia. But clearly they are not being abstinent, nor are their peers across Texas. According to the CDC’s 2013 Youth Risk Behavior Survey, 43 percent of high school girls and 49 percent of high school boys in Texas have engaged in sexual intercourse. Texas also has the third-highest rate of teen pregnancy across the country. And, in 2012, there were nearly 40,000 cases of chlamydia among teenagers 15 and older reported in Texas.

These statistics should be enough to get everyone paying attention to the poor sexual health of teens in Texas, and similar statistics are available for states across the country. But the media tends to gloss over these health indicators or report them in a brief news story without ever investigating what we are doing wrong. Apparently, it takes a story like Crane to make the general public take notice.

Only what we have learned since the story broke is that the “outbreak” of chlamydia that was reported in Crane was greatly exaggerated. Some reporters began questioning the numbers because the local health department listed only eight cases of chlamydia in the whole county. Rumage has since agreed that his number was incorrect and explained that he got his information from a local doctor and that he misheard or possibly misunderstood. When the doctor said that more than 20 students had been tested for chlamydia he took that to mean they all had the infection. In fact, only three cases have been confirmed among students, though not all test results have come back.

But three high school students with chlamydia is bad news. Chlamydia is an easily treatable bacterial infection, if caught early, but it often has no symptoms and young people won’t know they have it unless they know to get tested for it. If they don’t get tested and treated, chlamydia can lead to pelvic inflammatory disease which, in turn, can lead to infertility. Moreover, the fact that three have chlamydia means that they are having unprotected sex and putting themselves in danger of contracting other STIs that can’t be cured, such as herpes and HIV. Given that we don’t know their gender, they are also at risk of getting pregnant or causing a pregnancy.

But is three students with chlamydia bad enough news to have made international headlines?

I doubt it. My guess is that if it had been clear from the start that this was not actually an epidemic, it wouldn’t have gotten past the local newspaper. Three chlamydia cases in one school is certainly alarming, but it’s not scandalous, and it doesn’t make for much of a headline.

I would argue, however, that it should. Every case of chlamydia or gonorrhea or herpes among teenagers should make headlines, or at least make us demand change, as should every teen who becomes unintentionally pregnant. These things can be prevented, and it is our responsibility as adults to give teens the information and tools necessary to prevent STIs and unplanned pregnancy. We also have to help them think critically about their sexual decisions, because if more than 20 kids in one high school needs to be tested for chlamydia, it means that at least some of them are having unprotected sex with multiple partners. Teens are capable of making responsible choices, but they can’t do it without the help of adults and education.

We may never have heard of Crane, Texas, or questioned its sexuality education if the truth had been known going in. Now that we have, though, we should not let the conversation drop. According to some reports, the school board in Crane was set to reexamine its sex education program early this week. I hope that the recent scrutiny on the town—whether deserved or not—spurs the board to improve its program and I hope that media stays on the story to keep the pressure on. I also hope that moving forward, it will not take an epidemic to get us to focus on the sexual health needs of teens—because the next epidemic will likely be real and it will be the teens who suffer.