Analysis Sexual Health

Millennial Attitudes on Reproductive and Sexual Health Show Promise for Advocates

Elizabeth Dawes Gay

A new survey suggests that advocates have an opportunity to engage millennials in working toward unfettered access to reproductive health information and services.

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

Last week, the Public Religion Research Institute (PRRI)—a nonprofit, nonpartisan organization that conducts research to better understand debates on public policy issues—released its new survey, How Race and Religion Shape Millennial Attitudes on Sexuality and Reproductive Health. One of the largest of its kind, the survey sought to examine how race, religion, and politics shape young people’s attitudes on reproductive and sexual health, as well as on morality and stigma.

Millennials—young adults born in the 1980s and 1990s—came of age during a time when antibiotic-resistant sexually transmitted infections became a public health threat, racial disparities in reproductive and sexual health outcomes persisted, and politicians continued to systematically deny and attack their ability to access sexual health information and health care services, such as contraception and abortion. That may be why, when compared to the general public, so many of the 2,314 young adults ages 18-to-35 in the survey were less likely to identify with either of the two major political parties, and have a pessimistic view about the direction of the country.

Also, my generation is the first generation to have not known a world before the risk of HIV and AIDS became a widely known epidemic—a sobering reminder of the context in which today’s young people were born and still live. This could explain why 87 percent of millennials believe health plans should cover HIV and STD testing.

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Fortunately, the report suggests that millennial attitudes about reproductive and sexual health are promising, especially around sexual health education, contraception, and abortion. Further, the findings of this poll and others published recently suggest advocates have an opportunity to engage millennials—estimated to be the nation’s largest living generation—in working toward unfettered access to reproductive health information and services.

Sex Ed

Seventy-five percent of millennials surveyed support comprehensive sex education in public schools. They want accurate information about their bodies, about sex and relationships, and about how to protect their health. That’s a big deal because one in four of those surveyed were not taught any sex education, and, among those who were, four in ten said their sex ed classes were not helpful to them in making sex and relationship decisions. In a nation where half of states require health educators emphasize abstinence-only, our policymakers are clearly out of touch with what young people want and needcomprehensive sex health education that is scientifically accurate and teaches young people how to protect themselves and have healthy relationships.

SisterReach, an organization based in Memphis, Tennessee, focused on empowering Black women and girls around their reproductive and sexual health, also released a report last week that emphasizes the need for comprehensive sex education, especially in a state that promotes abstinence-only education. The report, Our Voices and Experiences Matter, found that misinformation often fills the gaps abstinence-only education leaves behind. According to the report, one teen in a focus group said, “Guys talk about trying to make their own condoms—Saran Wrap.”

The focus groups found that teens, their parents, and their teachers show a desire and need for curriculum that provides young people with scientifically accurate information and equips them to make healthy decisions.  The report concludes that Tennessee must change its sex ed curriculum and include input from young people, parents, and teachers.

Lack of appropriate and accurate sexual health education ultimately affects the health and life outcomes of the young people. For example, researchers found that young people who received comprehensive sex ed were less likely to report pregnancy than those who received abstinence-only education.

Contraception

According to the report, millennials want access to contraception even more than they want comprehensive sex education taught in public schools. More than half (55 percent) of those surveyed are opposed to requiring a prescription for emergency contraception. Seventy-eight percent support making all forms of contraception readily available on college campuses, and 82 percent think prescription birth control should be covered by health insurance. Additionally, 81 percent support increasing access to contraception for women who cannot afford it. The availability and affordability of contraception matters to millennials and a large majority—both Democratic and Republican millennials alike—believe using contraception is morally acceptable.

Support for the increased availability and affordability of contraception is nothing new. Specifically, a 2013 poll found that African Americans of all ages and religious and political affiliations overwhelmingly view contraception as basic health care that should be covered, along with testing for sexually transmitted infections and abortion care, by health insurance.

All of this recent research suggests millennials want to decide whether and when to have children, and want people to have ready access to the information and services they need to carry out their decisions.

Abortion

At first glance, survey respondents appear to be divided ideologically among religious and political lines when it comes to abortion, but a closer look yields some encouraging insights. Amongst all respondents, just over half (55 percent) think abortion should be legal in all or most cases and oppose making abortion more difficult to obtain. But those who know someone who had an abortion are more likely to oppose restricting access to safe abortion care. Among those who have had an abortion themselves, 73 percent oppose making it more difficult to access, and 79 percent say abortion should be legal in all or most cases.

Data from the reproductive health field confirm that individuals are willing to be non-judgmental and support those who seek abortion care. As recently as 2014, polling commissioned by the National Latina Institute for Reproductive Health showed that—among Latino voters in Texas—78 percent agree that a woman has the right to make her own personal decisions about abortion, and eight in ten would offer support to a loved one who had an abortion.

These data, as well as other data in the PRRI report not covered here, demonstrate that individual reproductive and sexual health decision making is important to young people and that they value having access to helpful information and health-care services. In fact, millennials are speaking up online, in the streets, and even on the steps of the U.S. Supreme Court to fight for the health care they need. As a generation that was born into a world with a growing number of health concerns and lives in a political environment that is hostile to reproductive health decisions, millennials recognize there is still a great deal of progress to be made. Our engagement, our advocacy, and our votes could turn the tide.

There will be opportunities to use this and other data to inform reproductive and sexual health policymaking. I hope those opportunities are taken and include the voices and perspectives of young people, because they could help improve the health outlook in the country for generations to come.

Roundups Law and Policy

Gavel Drop: Republicans Can’t Help But Play Politics With the Judiciary

Jessica Mason Pieklo & Imani Gandy

Republicans have a good grip on the courts and are fighting hard to keep it that way.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts.

Linda Greenhouse has another don’t-miss column in the New York Times on how the GOP outsourced the judicial nomination process to the National Rifle Association.

Meanwhile, Dahlia Lithwick has this smart piece on how we know the U.S. Supreme Court is the biggest election issue this year: The Republicans refuse to talk about it.

The American Academy of Pediatrics is urging doctors to fill in the blanks left by “abstinence-centric” sex education and talk to their young patients about issues including sexual consent and gender identity.

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Good news from Alaska, where the state’s supreme court struck down its parental notification law.

Bad news from Virginia, though, where the supreme court struck down Democratic Gov. Terry McAuliffe’s executive order restoring voting rights to more than 200,000 felons.

Wisconsin Gov. Scott Walker (R) will leave behind one of the most politicized state supreme courts in modern history.

Turns out all those health gadgets and apps leave their users vulnerable to inadvertently disclosing private health data.

Julie Rovner breaks down the strategies anti-choice advocates are considering after their Supreme Court loss in Whole Woman’s Health v. Hellerstedt.   

Finally, Becca Andrews at Mother Jones writes that Texas intends to keep passing abortion restrictions based on junk science, despite its loss in Whole Woman’s Health.

Culture & Conversation Human Rights

Let’s Stop Conflating Self-Care and Actual Care

Katie Klabusich

It's time for a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities.

As a chronically ill, chronically poor person, I have feelings about when, why, and how the phrase “self-care” is invoked. When International Self-Care Day came to my attention, I realized that while I laud the effort to prevent some of the 16 million people the World Health Organization reports die prematurely every year from noncommunicable diseases, the American notion of self-care—ironically—needs some work.

I propose a shift in the use of “self-care” that creates space for actual care apart from the extra kindnesses and important, small indulgences that may be part of our self-care rituals, depending on our ability to access such activities. How we think about what constitutes vital versus optional care affects whether/when we do those things we should for our health and well-being. Some of what we have come to designate as self-care—getting sufficient sleep, treating chronic illness, allowing ourselves needed sick days—shouldn’t be seen as optional; our culture should prioritize these things rather than praising us when we scrape by without them.

International Self-Care Day began in China, and it has spread over the past few years to include other countries and an effort seeking official recognition at the United Nations of July 24 (get it? 7/24: 24 hours a day, 7 days a week) as an important advocacy day. The online academic journal SelfCare calls its namesake “a very broad concept” that by definition varies from person to person.

“Self-care means different things to different people: to the person with a headache it might mean a buying a tablet, but to the person with a chronic illness it can mean every element of self-management that takes place outside the doctor’s office,” according to SelfCare. “[I]n the broadest sense of the term, self-care is a philosophy that transcends national boundaries and the healthcare systems which they contain.”

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In short, self-care was never intended to be the health version of duct tape—a way to patch ourselves up when we’re in pieces from the outrageous demands of our work-centric society. It’s supposed to be part of our preventive care plan alongside working out, eating right, getting enough sleep, and/or other activities that are important for our personalized needs.

The notion of self-care has gotten a recent visibility boost as those of us who work in human rights and/or are activists encourage each other publicly to recharge. Most of the people I know who remind themselves and those in our movements to take time off do so to combat the productivity anxiety embedded in our work. We’re underpaid and overworked, but still feel guilty taking a break or, worse, spending money on ourselves when it could go to something movement- or bill-related.

The guilt is intensified by our capitalist system having infected the self-care philosophy, much as it seems to have infected everything else. Our bootstrap, do-it-yourself culture demands we work to the point of exhaustion—some of us because it’s the only way to almost make ends meet and others because putting work/career first is expected and applauded. Our previous president called it “uniquely American” that someone at his Omaha, Nebraska, event promoting “reform” of (aka cuts to) Social Security worked three jobs.

“Uniquely American, isn’t it?” he said. “I mean, that is fantastic that you’re doing that. (Applause.) Get any sleep? (Laughter.)”

The audience was applauding working hours that are disastrous for health and well-being, laughing at sleep as though our bodies don’t require it to function properly. Bush actually nailed it: Throughout our country, we hold Who Worked the Most Hours This Week competitions and attempt to one-up the people at the coffee shop, bar, gym, or book club with what we accomplished. We have reached a point where we consider getting more than five or six hours of sleep a night to be “self-care” even though it should simply be part of regular care.

Most of us know intuitively that, in general, we don’t take good enough care of ourselves on a day-to-day basis. This isn’t something that just happened; it’s a function of our work culture. Don’t let the statistic that we work on average 34.4 hours per week fool you—that includes people working part time by choice or necessity, which distorts the reality for those of us who work full time. (Full time is defined by the Internal Revenue Service as 30 or more hours per week.) Gallup’s annual Work and Education Survey conducted in 2014 found that 39 percent of us work 50 or more hours per week. Only 8 percent of us on average work less than 40 hours per week. Millennials are projected to enjoy a lifetime of multiple jobs or a full-time job with one or more side hustles via the “gig economy.”

Despite worker productivity skyrocketing during the past 40 years, we don’t work fewer hours or make more money once cost of living is factored in. As Gillian White outlined at the Atlantic last year, despite politicians and “job creators” blaming financial crises for wage stagnation, it’s more about priorities:

Though productivity (defined as the output of goods and services per hours worked) grew by about 74 percent between 1973 and 2013, compensation for workers grew at a much slower rate of only 9 percent during the same time period, according to data from the Economic Policy Institute.

It’s no wonder we don’t sleep. The Centers for Disease Control and Prevention (CDC) has been sounding the alarm for some time. The American Academy of Sleep Medicine and the Sleep Research Society recommend people between 18 and 60 years old get seven or more hours sleep each night “to promote optimal health and well-being.” The CDC website has an entire section under the heading “Insufficient Sleep Is a Public Health Problem,” outlining statistics and negative outcomes from our inability to find time to tend to this most basic need.

We also don’t get to the doctor when we should for preventive care. Roughly half of us, according to the CDC, never visit a primary care or family physician for an annual check-up. We go in when we are sick, but not to have screenings and discuss a basic wellness plan. And rarely do those of us who do go tell our doctors about all of our symptoms.

I recently had my first really wonderful check-up with a new primary care physician who made a point of asking about all the “little things” leading her to encourage me to consider further diagnosis for fibromyalgia. I started crying in her office, relieved that someone had finally listened and at the idea that my headaches, difficulty sleeping, recovering from illness, exhaustion, and pain might have an actual source.

Considering our deeply-ingrained priority problems, it’s no wonder that when I post on social media that I’ve taken a sick day—a concept I’ve struggled with after 20 years of working multiple jobs, often more than 80 hours a week trying to make ends meet—people applaud me for “doing self-care.” Calling my sick day “self-care” tells me that the commenter sees my post-traumatic stress disorder or depression as something I could work through if I so chose, amplifying the stigma I’m pushing back on by owning that a mental illness is an appropriate reason to take off work. And it’s not the commenter’s fault; the notion that working constantly is a virtue is so pervasive, it affects all of us.

Things in addition to sick days and sleep that I’ve had to learn are not engaging in self-care: going to the doctor, eating, taking my meds, going to therapy, turning off my computer after a 12-hour day, drinking enough water, writing, and traveling for work. Because it’s so important, I’m going to say it separately: Preventive health care—Pap smears, check-ups, cancer screenings, follow-ups—is not self-care. We do extras and nice things for ourselves to prevent burnout, not as bandaids to put ourselves back together when we break down. You can’t bandaid over skipping doctors appointments, not sleeping, and working your body until it’s a breath away from collapsing. If you’re already at that point, you need straight-up care.

Plenty of activities are self-care! My absolutely not comprehensive personal list includes: brunch with friends, adult coloring (especially the swear word books and glitter pens), soy wax with essential oils, painting my toenails, reading a book that’s not for review, a glass of wine with dinner, ice cream, spending time outside, last-minute dinner with my boyfriend, the puzzle app on my iPad, Netflix, participating in Caturday, and alone time.

My someday self-care wish list includes things like vacation, concerts, the theater, regular massages, visiting my nieces, decent wine, the occasional dinner out, and so very, very many books. A lot of what constitutes self-care is rather expensive (think weekly pedicures, spa days, and hobbies with gear and/or outfit requirements)—which leads to the privilege of getting to call any part of one’s routine self-care in the first place.

It would serve us well to consciously add an intersectional view to our enthusiasm for self-care when encouraging others to engage in activities that may be out of reach financially, may disregard disability, or may not be right for them for a variety of other reasons, including compounded oppression and violence, which affects women of color differently.

Over the past year I’ve noticed a spike in articles on how much of the emotional labor burden women carry—at the Toast, the Atlantic, Slate, the Guardian, and the Huffington Post. This category of labor disproportionately affects women of color. As Minaa B described at the Huffington Post last month:

I hear the term self-care a lot and often it is defined as practicing yoga, journaling, speaking positive affirmations and meditation. I agree that those are successful and inspiring forms of self-care, but what we often don’t hear people talking about is self-care at the intersection of race and trauma, social justice and most importantly, the unawareness of repressed emotional issues that make us victims of our past.

The often-quoted Audre Lorde wrote in A Burst of Light: “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”

While her words ring true for me, they are certainly more weighted and applicable for those who don’t share my white and cisgender privilege. As covered at Ravishly, the Feminist Wire, Blavity, the Root, and the Crunk Feminist Collective recently, self-care for Black women will always have different expressions and roots than for white women.

But as we continue to talk about self-care, we need to be clear about the difference between self-care and actual care and work to bring the necessities of life within reach for everyone. Actual care should not have to be optional. It should be a priority in our culture so that it can be a priority in all our lives.