A New Way to Learn About Abortion

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Abortion: a Constitutional Right and Contentious Topics

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Abstinence-only Sex Education and the ACA

I learn something new every day. There has been a lot of news recently about the Patient Protection and Affordable Care Act (ACA) as the nation celebrated its two-year anniversary (or not, in the case of opposition). Also, today the Supreme Court concluded its review of the health care bill. I support many aspects of the ACA. Although many aspects of the ACAwill be enacted at different times, the Act: does not allow health insurance companies to deny someone coverage because of pre-existing health conditions; allows children to be covered under their parent's health insurance until they are 26; requires health insurance companies to cover, free of charge, preventable health services such as vaccines, mammograms and screening for conditions like obesity and Type II diabetes. Also, this March it became mandatory that federal health programs collect racial, ethnic and language data which will perhaps help us better understand health disparities. However, thanks to a CNN article I learned that the Act also renewed $50 million per year for five years, for abstinence-only sexual education.

Abstinence-only sex education was something I heard about long ago. Then I really began to pay attention to the issue while I was a Public Policy Fellow at Gay Men's Health Crsis in 2009. Abstinence-only sex education places a great emphasis on waiting to have sex until after marriage. Such education often minimizes the biological aspects of sex, and often speaks very little about the use of condoms and birth control, if at all. Such education has been linked to increased rates of teen pregnancy and contraction of sexually transmitted infections. One 2011 study at the University of Georgia examined the correlation between abstinence-only sex education and teen pregnancies, births and abortions.

For every state, the investigators examined education laws and other policies regarding sex and/or HIV/AIDS education. Actual education laws were retrieved from the Education Commission on the States, while other related policies were retrieved from the Sexuality Information and Education Council of the US (SIECUS). All but two states (Wyoming and North Dakota) had education laws and/or policies on record. Each state's laws and policies were assigned a number from 0-3 indicating the level of importance each state placed on abstinence from sex; level 0 laws indicated no specific mention of abstinence, while level 3 indicated that abstinence from sex until marriage was the fundamental teaching standard. The policy level for each state was correlated with data on teen pregnancy, and birth and abortion rates. The investigators also accounted for population factors like socioeconomic status, education level, ethnicity and access to Medicare waivers for family planning.

The results? States that were described as Level 3 (abstinence was their fundamental teaching standard) had the highest rates of teen pregnancy and births among teen moms. The investigators also found that richer states tended to have a higher proportion of white teens in their teen populations, and emphasized abstinence less. These richer states also tended to have lower teen pregnancy and birth rates than poorer states. These results support the notion that abstinence-only sex education is ineffective.

Politics often involves compromise between the concerned parties. In June 2009, when I was a Public Policy Fellow, the major source of funding for abstinence-only education expired. A new bill was signed in December 2009 that provided $114 million to more comprehensive and evidence-based sex education (hooray)! Therefore, I was surprised to learn that the ACA provided funding for abstinence-only education which yields questionable outcomes. But like I said-- compromise.

The debate about whether or not abstinence-only sex education works is important; however, it is the unwanted outcomes with which we should be very concerned. The University of Georgia study found that teenage pregnancy was strongly correlated with ethnicity and socioeconomic background. Public health campaigns that target high-risk populations to educate them about teen-pregnancy and provide better access to preventative services will be invaluable moving forward.

An International Dilemma: Barriers to Sexual and Reproductive Rights

By Alexa Mieses

Picture taken from Nature.com

The New York Times reported today that a vaginal microbicidal gel has given women in one study a 39% chance of protection from the HIV virus. The microbicide contains a nucleotide reverse transcriptase inhibitor, which prevents the virus from reproducing. The study involved a double-blind, randomized controlled trial which compared tenofovir gel (the microbicide) with placebo gel in sexually active, HIV-uninfected 18- to 40-year-old women in urban and rural parts of South Africa. The study involved 30 months of follow-up with each of the women to assess their HIV serostatus, safety, sexual behavior, and gel and condom use. Read the original journal article here.

If such a microbicide is approved, to what extent will African women have access to the vaginal gel? One issue is cost. As the New York Times article mentions, each dose of gel is cheap, however, the patented applicators are rather expensive (forty cents each). Also, men have the authority in most African sexual relationships. While the microbicide may allow an African woman to decrease her chances of contracting HIV without the man's knowledge, will the fact that many physicians are male create a barrier to access of the gel? As of 2006, 70% of all physicians registered with the Health Professions Council of South Africa were male. Will a male dominated world serve as a barrier for African women to obtain the gel? I ask this question because in other countries like Chile and the United States, religious beliefs or political agendas, not whether one is male or female, has created barriers to certain reproductive rights.

The recent history of the emergency contraceptive pill in Chile is more of a flip-flop story of conflicting ideals. In 2006, first female and former Chilean president, Michelle Bachelet, began to more firmly advocate for women's contraceptive rights. By 2007, a presidential mandate made authorities ensure that public health centers made emergency contraception, or the morning-after pill, available. By 2008, courts ruled to only make the pill available in pharmacies and required a prescription. Read more here. Pharmacists would often refuse to sell the pill to women, even with a prescription, sometimes claiming the pill was "out of stock." In reality, religious beliefs instilled in many of the country's people (and pharmacists), often served as the basis for such behavior. Nearly 100 pharmacies were found failing to stock the pill altogether. In early 2010, at the end of her presidency, Bachelet once more was able to sign legislation that allowed the pill to be distributed freely throughout Chile. However, women in Santiago still report a stigma surrounding the purchase of the morning-after pill.

Africa and South America are not the only continents in which access to certain reproductive rights has been an issue. Abortion, while it is a very sensitive subject to some, has been the center of American media and political debate for some time. Since the Supreme Court ruling of Roe v. Wade in 1973, abortion has been legal. However, despite the fact that it is not illegal in many states, there are many barriers that sometimes make it impossible to have an abortion. While most restrictions regarding length of gestation are put in place for good reason, many states create certain restrictions which make it difficult for a woman to undergo an abortion. Also, women with little money or no health insurance often cannot pay for abortions. Additionally, in some places there is limited availability for medical training on abortion. The Association of Reproductive Health Professionals reported that although the Accreditation Council on Graduate Medical Education now requires that training in abortion be made available to all Ob/Gyn residents, as of 2008 only half of Ob/Gyn residency programs offer routine training in abortion care. Finally, violence and harassment of women seeking abortion and/or health care professionals that perform abortions, has created a barrier to the procedure.

As technology develops and new procedures and drugs are created, the political milieu of countries across the globe and women's rights also evolve. Regardless of the moral foundation upon which you stand, it is important to always remain well-informed of scientific developments to better take care of your health.