The Sex Ed Hall of Shame (reprint from Salon.com)

In light of NYC’s mandate, we look at states with the worst policies when it comes to the birds and the bees
The sex ed hall of shame

iStockphoto/Salon

This week people were abuzz over news that New York City had mandated sex education — and some were simply scratching their heads at the realization that this wasn’t already the case. Seriously, it took this long?

Well, seriously, there are still 24 states that haven’t mandated sex education, including New York state.

That’s too many states to cover in any detail, so I’ll narrow it down to the worst of them. These are states that not only fail to mandate sex ed, but require that when it is taught, abstinence and the “importance of sex only within marriage” are stressed. These states make sure to defend “traditional” values, but they don’t protect scientific ones: Unlike some states, they don’t require that classes provide medically accurate information. Without further ado, the embarrassing eight that meet this criteria:

  • Alabama has “among the highest rates of chlamydia, gonorrhea, and syphilis of any state in the union,” according to youth advocate Amplify, and has the 15th highest teen pregnancy rate in the country. Another not-so-fun fact: It bans schools from teaching anything positive about homosexuality.
  • Arkansas has landed on some unfortunate top-ten lists: When it comes to STI rates among young people, it ranks 5th in terms of chlamydia, 7th for gonorrhea and 10th for syphilis. It also has the 8th highest teen pregnancy rate in the country.
  • Florida has the sad distinction of ranking 1st in HIV infections and 12th in teen pregnancies.
  • Indiana fares well in terms of teen pregnancy and STI rates — relatively speaking — but the state’s teens “are among the least likely to report having used condoms the last time they had sex,” according to Amplify.
  • Louisiana has the highest syphilis rate among young people in this country. It’s also in the top ten for both chlamydia and gonorrhea, and 11th in terms of teen HIV.
  • Missouri was given a “C” rating on teen health by Amplify — while most of the states on this list received closer to a “D” — but, still, “the state has higher than average rates of STIs and lower than average rates of condom use among sexually active high school students.”
  • Texas has several claims to sex-shame: It ranks 5th for teen pregnancy, 3rd in young people with AIDS and 4th in terms of syphilis among teens. A whopping 96 percent of Texas school districts teach abstinence only, according to a study by the Texas Freedom Network.
  • Virginia has the 8th highest syphilis rate among young people. While it’s seen a decline in unplanned pregnancies, a study found that between 1991 and 2004 teen births still cost taxpayers roughly $3.1 billion.

The good news is that there are 20 states, along with the District of Columbia, that currently mandate sex education. But that’s a very basic achievement — it says nothing of the requirements and restrictions that are made on curricula across the country. Guttmacher reports that “26 states require that abstinence be stressed” in sex ed classes; meanwhile only 19 states insist on any mention of contraceptives. And we wonder why the U.S. has the highest teen birth rate in the developed world.

U.S. Health Care Insurance: Picking on Women

The United States would have the best health care system in the world if it weren’t for its insurers. I’ve had health insurance for forty years and I’ve never seen such a mess as we’re experiencing right now. A recent event in my own life brought this home to me:

I had a routine mammogram this spring and was surprised—and dismayed—when I received a letter saying that I needed a follow-up breast ultrasound because of some suspicious findings. I had to wait over a month for my appointment. I stayed calm and told myself that it probably wasn’t anything. And I was right. There was nothing there. I just have very dense breasts and it was hard to see just what was going on in the initial mammogram. After taking more extensive x-rays it was decided that an ultrasound wasn’t even necessary.

Good thing, because I would have had to pay out of pocket for that, too.

It seems that my insurance company is refusing to pay for the second mammogram because they only authorize one a year. So I’m going to have to foot the $200 bill.

Tell me, please, what I should have done? My doctor ordered the follow-up mammogram to make sure that I wasn’t developing breast cancer. I didn’t ask for the second mammogram. If I’d known my insurance wouldn’t pay for it, would I have had it done? Maybe not.

I don’t have the $200 but I may be able to work out a payment plan. I can pay it off over time. But what about people who can’t even afford to do that? All this policy is going to do is prevent people from undergoing health procedures that just might save their lives.

If I’d had breast cancer, would my insurance company have paid for additional mammograms as I underwent treatment? Or would they charge me for each of them on the grounds that they only pay for one a year?

I recently read that physicians’ associations are now recommending that annual mammograms should begin at the age of 40. Right now most insurance companies are going by the older guidelines which say that mammograms are not “cost-effective” if a woman is under 50. That’s right. Apparently, they don’t think that enough breast cancer is detected between the ages of 40 and 50 to justify the cost of administering the ten mammograms during that decade.

This is despite the fact that breast cancer is usually much more aggressive in younger women. I myself know three women in their 30s who died of breast cancer.

I guess I’m lucky that I’m old enough to qualify for one mammogram a year. But what if I was younger and had a family history of breast cancer? What if it was determined that I had the markers for it? Would my insurance company still refuse to pay for mammograms that my doctor would most likely order?

Another area in which women are being short-changed by the health insurance system is reproductive care. Contraception has gotten much more expensive, but it’s more expensive still to get pregnant and have a baby. So why aren’t insurers attempting to keep the costs of contraception down? Many years ago, I used to get my birth control pills for free or only a small co-pay. Now they can cost the insured $40 or $50 a month. It would be hard for me to come up with that much money each month for contraception. But what choice would I have?

Some insurance companies are batting around the idea that women should have to pay for additional coverage for possible pregnancies and abortions. That’s like making men pay extra because of the possibility that they might become impotent. And I thought that health insurers were no longer supposed to deny people health care coverage because of pre-existing conditions. Isn’t being a man or a woman a pre-existing condition?

I plan to dispute my insurance company’s decision about my mammogram but the chances of winning are probably not good. I have to try, though. We all have to try. We need to stick up for ourselves when it comes to health care for ourselves. We need to protest unfair and discriminatory denials. And we need to keep ourselves informed about what’s going on in the world of health insurance.

UPDATE: It seems that my insurer is not refusing to pay for the mammogram, they just applied it to my deductible. They would have paid for it if it had been considered “preventative.” But an additional diagnostic mammogram is not considered preventative. Bottom line is: I still have to pay for it myself.

I asked what would have happened if I did have breast cancer. I was told that once my deductible is used up, the insurance would pay for treatment at 85% until I hit the $5000 deductible for catastrophic illnesses. I told the representative that I found this very confusing. Her answer? “Yes, it certainly is.”

 

 

 

 

Plans for Planned Parenthood

In a news story this morning about the possible government shut-down, it was reported that:

There were hints of Republican flexibility on a ban they were seeking to deny federal funds to Planned Parenthood. Officials said that in talks at the White House that stretched on after midnight on Wednesday, Republicans had suggested giving state officials discretion in deciding how to distribute family planning funds that now go directly from the federal government to organizations such as Planned Parenthood.

That would presumably leave a decision on funding to governors, many of whom oppose abortion, and sever the financial link between the federal government and an organization that Republicans assail as the country’s biggest provider of abortions.

If this is what happens, that would send a very clear message to Americans: Your federal government does not stand behind reproductive health care for women. Instead, it is willing to leave millions of women at the mercy of their state legislatures, some of which have already demonstrated that they are anti-abortion (and not very friendly toward birth control either).

This, in turn, would weaken Roe v. Wade. After all it is the U.S. Supreme Court that ruled on Roe v. Wade. If the federal government gives in on funding for Planned Parenthood, that might influence the Court the abortion issue ever comes before it again.

What are the chances that will happen? It would take a perfect storm of just the right conditions, according to Tony Lauinger, chairman of Oklahomans for Life:

“Ultimately it will require a pro-life president to nominate a pro-life Supreme Court justice who will be confirmed by a pro-life U.S. Senate to provide the fifth pro-life vote on the U.S. Supreme Court to overturn Roe v. Wade,” Lauinger said. “That has been a long-time goal.” Should Roe v. Wade be overturned, Lauinger said the most likely result would be that each state would determine whether abortions would be legal or not. The Supreme Court would return the matter to its status prior to 1973.

For the life of me, I can’t figure out why this nation would want to go back to conditions before 1973.  When I had my abortion in 1971, New York was the only state that had legalized abortion. I was fortunate because I live relatively close to New York. But what about women, who are going to have an abortion anyway, who don’t have the means to travel to a state where abortion is legal. Will they seek out illegal abortion providers and run the risk of being criminalized for doing so? Will we return to the days when women would try to abort themselves, often dying or making themselves sterile in the process?

 

How About a Marathon for Mental Illness?

I’ve never heard of a marathon for mental illness.* We have them for birth defects, breast cancer, AIDS, muscular dystrophy, heart disease and even some “orphan” diseases. But not for mental illness. Not for depression, anxiety, bipolar disorder, schizophrenia or other kinds of psychosis.

It can’t be because there aren’t that many people affected by mental illness. Mental illness is the leading cause of disability in the U.S. and Canada. (See source below.**) What if it could be treated successfully, or even cured? Just think of all the anguish that could be assuaged, the marriages that could be salvaged, the prison populations that could be reduced and the individuals who could be restored to full productivity. And of course all of that translates into billions of dollars in savings.

So why don’t we do more to alleviate the problems associated with mental illness? There are principally three reasons why we don’t.

1) Mental illness is grossly misunderstood. Most people are confused about what constitutes mental illness. We don’t know how to differentiate between “normal” depression or anxiety and the kind of depression or anxiety that completely debilitates a person, for instance. Not even the medical profession agrees on the causes and appropriate treatments.

2) Crazy people scare us. We are afraid that they’ll do damage to themselves or others. We steer clear of them whenever possible. Sometimes we even act like we think that mental illness is contagious. We joke about it (“Mental illness is catching. I caught it from my kids”), but never treat it seriously. We don’t talk about it in polite company in the same way that we would talk about cancer or even alcoholism.

3) Because mental illness can’t be “seen” in the same way as other diseases, we tend to think that it’s all in the sufferer’s head. It’s a figment of his or her imagination or a matter of learning how to think good thoughts. We don’t believe that it can be a real disability; we assume that the mentally disabled person is just playing the system.

I’m very familiar with all of these reasons. I don’t even understand my own mental illness. And yes, it scares me sometimes. And I constantly doubt whether or not I’m really disabled.

It’s humiliating to admit that you can’t handle things that other people seem to be able to. It’s frightening when you exhibit behavior that others consider to be just plain crazy. And it’s a terrible feeling when you realize that you don’t have control over your own mind.

One thing I try not to do is blame my mental illness for my behavior and personality traits. But it’s hard to draw the line between staying home and feeling sane and putting myself in situations where I get so anxious I can barely function. I try to keep my life as uncomplicated as possible because I don’t handle stress well at all, but even I get impatient about the lack of excitement in my life.  I understand why some people go off their meds: they’re tired of not feeling anything.

The problem is, there is no one effective treatment for mental illness. (Not to mention that there are so many different kinds of mental illness.) And so far there is no cure. I will probably always have to take medication for my depression and anxiety. When I don’t (as I have discovered when I run out of meds or am lax about taking them), I fall apart. Even when I do take them, I can easily tip over the edge. And yet I hate that weakness within me.

But what is even worse is how others look at you when they know you have a mental illness. Some people just flat out don’t believe you. Others worry about you unduly. And still others steer clear of you completely. You become afraid that people won’t want to befriend you, date you, marry you, have children with you, vote for you, or hire you. And often you’re right. Sometimes even you doubt your ability to do these things. And the sad thing is, sometimes you can’t. At least, not without help.

My own children doubt the extent of my mental illness. They think it’s awful that I take so many medications. They think if I had a different psychiatrist I’d be able to overcome them.

Each mentally ill person deals with their condition as best they can. It’s easy to be on the outside and prescribe ways to “get over it.”  But until you’ve suffered from a mental illness, you have no idea what the mentally ill person is up against. She has to use her own mind to deal with things that are going wrong with it. He may not even realize that he has a mental illness. But the main reason why the mentally ill don’t get treatment is because of the stigma associated with it.

It’s obvious that society is not willing to deal with mental illness. Most health insurance plans are woefully inadequate when it comes to mental health coverage. 10-15 visits a year is average; inpatient care has high deductibles, and brand name medications, which are usually Tier Three, are expensive. Hour-long visits for psychotherapy are almost never covered; you’re lucky to get a 15-minute medication check for when you go in for one of your limited number of appointments.

We don’t lock people up in insane asylums the way we used to (partly because the state doesn’t want to pay for mental hospitals any more). But being mentally ill is like being in prison and even when you’re being treated for it, you feel like an ex-con.

When there are marathons for breast cancer the participants proudly advertise that they are or know breast cancer survivors. No one would announce that fact if we were having a marathon for mental illness. In fact, it’s likely that no one would come.

**Read David Schimke’s essay on mental illness from the latest issue of Utne Reader.

Read about the father who has run over a hundred marathons on behalf of his daughter who suffers from schizophrenia. His dream is to organize marathons to help to erase the stigma associated with mental illness. I hope he is successful.

*That’s not entirely true: I did find some information about a STOMP OUT STIGMA  (SOS) marathon to be run in October, 2011 which is sponsored by the Depression and Bipolar Support Alliance of Greater Chicago. But that doesn’t erase the fact that public support for mental illness is almost non-existent.

House Republicans Jeopardize Women’s Health Care

Last Friday (Feb. 18)  House Republicans voted 240-185 to ban federal funding for Planned Parenthood.

I find this incomprehensible. Planned Parenthood is a respectable, indispensable source of health care for low and middle income women that has been around for 95 years. For some women it is their first, and sometimes only, contact with gynecological health care. Since we still don’t have universal health care in this country, that’s not likely to change any time soon.

Planned Parenthood is not an abortion mill. Only 3% of its services have to do with abortion counseling and procedures. That means that most women who walk into a Planned Parenthood facility do so for birth control, breast exams and Pap smears, and testing for STDs.  [Planned Parenthood’s 2008-2009 annual report states: “For the three million patients our doctors and nurses saw, we provided contraception (36 percent of our total services), testing and treatment for sexually transmitted infections (31 percent), cancer screening and prevention (17 percent), and abortion services (three percent).”]

Estimated savings from this proposed bill are $347,000. That’s peanuts in a $3.6 trillion dollar federal budget, but one-third of the yearly income for Planned Parenthood. Where is that money going to come from if the federal government withdraws its support? But if the fact that Planned Parenthood offers abortion services at all bothers some people, then why not cut the amount being given to Planned Parenthood by the amount of its income that comes from abortions: 3%?  Why take away all federal support of an institution that provides essential health care for over 3 million women a year.?

Ironically, those who argue for limited government intervention are more than willing to put the government in charge of what women can do with their bodies. Government should never be about restricting choices, but about freedom.

Some argue that the private sector will have to pick up the cost of abortions. What that means is that all women should have to pay for their abortions completely out of pocket unless they’re victim of rape or incest or their health is compromised by a pregnancy. Because more and more health insurance plans are refusing to pay for elective abortions, and some won’t pay for abortions under any circumstances. In some instances, women are being forced to buy additional riders for abortion coverage. That’s ludicrous. Women don’t plan to have abortions any more than they plan to get cancer.

If these lawmakers were really concerned about cutting the budget, they should be for, not against, abortions. For example, one of my daughters recently had a D&C after a miscarriage. It cost $4600. If she had had an abortion when her baby’s abnormalities were first diagnosed, it would have cost approximately $350-950 at Planned Parenthood. [Source here.] If she had not had a miscarriage or an abortion, but her baby had been born with severe complications, it would have cost a great deal more.

Conservatives like to cite the irresponsibility of single mothers and “welfare queens” as one reason why our federal budget is so high. And yet they are willing to severely cripple the effectiveness of one organization that helps women to be more responsible about when or whether they will have children. Shame on the House Republicans and anyone else who votes for this proposal.

Read Rebecca Traister’s excellent article about this issue here.

A True Story About Loss and Making Hard Decisions

It’s one thing to debate the fine points of feminism, such as the insistence on protecting a woman’s right to choose whether or not to have an abortion. It’s quite another thing to have a real-life situation come up which tests your convictions.

I found this out over the last few weeks, starting with my daughter’s phone call telling me the results of her ultrasound.

The news wasn’t good.

She ended up having a second ultrasound and then a more invasive test (CVS) where cells are taken from the placenta to be examined for some forms of birth anomalies.

The results: her baby—a girl—had Down syndrome and Turner syndrome.

Now, Down syndrome alone is not a death sentence, although the defects associated with it can be life-threatening. And there are cases of girls with Turner Syndrome functioning just fine (except for infertility). But if the chromosomal mutations are severe enough, the baby will not survive and that is exactly what my daughter was told by the doctors.

Sure enough, around the 11th week of pregnancy, the baby died and my daughter had to have a procedure to remove the baby’s remains (including the placenta) from her uterus.

But in the weeks between the initial diagnosis of a birth defect and the actual miscarriage, my daughter and her partner were haunted by the question of whether or not to go ahead and terminate the pregnancy.

I am pro-choice. I adamantly reject the idea that a woman should be forced to have a baby under any circumstances. As it is right now, most states only allow abortions in the case of rape, incest or threat to the mother’s health. I would hate to think that any woman would be denied the right to terminate a pregnancy that was going to kill her, or where she would be having the child of her rapist, forever tying her to the man who raped her, or where her child would also be her half-sister or -brother, for instance.

But I am also pro-life. I firmly believe that all life is sacred. However, I also happen to be against capital punishment and war, when, strangely enough, many pro-lifers are not. I also fail to see where the life of the mother is not as important as the life of her baby, maybe even more so if she has other children who need her.

And yet, there is a part of me that believes that sometimes a person has to make a hard decision, one that would normally be left to God, and that is to terminate a pregnancy when the results are going to be traumatic.

One thing that makes me crazy about people who are anti-abortion is their refusal to admit that some babies are not wanted, not loved and not cared for. What good does it do to force a woman to have a severely handicapped child when she doesn’t have the resources necessary for her to care for the child properly? Is someone going to step in and take over the responsibility? Not likely. (And those resources can be physical, psychological, mental, social, educational or economic.)

What if a woman with Down Syndrome gets pregnant? Are we supposed to force her to have a baby she can’t raise by herself (if at all)? And what about a woman who already has other children whose lives would be negatively impacted by the arrival of a severely handicapped brother or sister? (In other words, why would the fetus’ rights take precedence over children’s who are already born?)

The thing is, there are not clear-cut answers for these questions. Every woman’s situation is different and she has the right to decide how much she can handle. And, most importantly, she should not be made to feel guilty if she chooses the alternative that people who don’t even know her think she should.

My daughter was spared from having to decide whether or not to have an abortion because the baby died naturally. But if she had decided to have an abortion, she would have been branded by some people as a “baby-killer.” People who are anti-abortion say no matter what the problem, the baby should be carried as long as possible, even if it dies in utero or at birth. Anything less and you’ve committed murder.

I say that’s nonsense. And it’s cruel.

Continue reading “A True Story About Loss and Making Hard Decisions”