Surgeon General Satcher: You Can't Have Good Health Without Good Policy

One day after President Obama vowed to do “everything in [his] power” to get health care reform passed in Congress, I had the opportunity to hear Former US Surgeon General Dr. David Satcher speak on the racial and ethnic inequalities in the United States’ health system at the Connecticut College 2010 Health Care Symposium. Satcher, who served as Surgeon General from 1998 to 2002, is the director of the Satcher Health Leadership Institute, established in 2006 to develop a diverse group of public health leaders, foster and support leadership strategies, and influence policies toward the reduction and ultimate elimination of disparities in health.

The health disparities between blacks and whites in America are huge; in terms of life expectancy, infant mortality rates, incidence of heart disease, cancer, and other common killers, African Americans are consistently much more likely to face serious issues for which they receive lesser care. In the simplest terms, Satcher’s argument was this: disparities are real and their determinants are clear, but it is impossible to have achieve equality without policy reform.

With African American babies more than twice as likely as Caucasian children to die in their first year of birth, Dr. Satcher focused much of his discussion on the importance of infant mortality initiatives. These programs address education, nutrition, prenatal care, physical environment, social factors, the health of the mother and child, and other crucial forms of assistance. However, in our own state, Governor Rell's Midterm Budget Adjustments have proposed to eliminate all funding for Fetal and Infant Mortality Review.

As evident from Dr. Satcher's keynote, state-level assistance programs are crucial. In all, his talk was an important reminder that not just health care, but the entire health system are in need of reform. Though education and outreach are equally important in combating deeply entrenched inequality, good health requires good policy and thus we at NARAL are committed to ensuring sexual and reproductive health, rights, and justice for all.

NARAL Pro-Choice Connecticut Joins Advocates in Support of Basic Workplace Standard for Paid Sick Days

Advocates in support of paid sick days for Connecticut’s worker’s came to the Legislative Office Building today to ask Connecticut lawmakers to pass S.B 63, which would allow workers at businesses with more than 50 employees to earn paid sick time—up to five days per year.

NARAL Pro-Choice Connecticut supports this important policy change because of the profound affect it can have on low income pregnant women in Connecticut and their access to adequate prenatal care. Low-income women in Connecticut have higher rates of inadequate, late or no prenatal care, have higher rates of low birth weight, and their babies are more likely to die than higher income earning women in the state.

Adequate prenatal care is necessary for a healthy pregnancy and healthy child and is directly linked to preventing mother and child from costly health conditions later on in life. During a healthy pregnancy a woman will visit her doctor twelve times. Low income working women in Connecticut should be given the opportunity to attend at least some of their prenatal visits without losing pay.

State Senator Edith Prague and State Senator John Kissel spoke out in support of SB 63, as did Connecticut Working Families, Connecticut Sexual Assault Crisis Services, and the Permanent Commission on the Status of Women.

Choice approached as a social experiment: Bump+

The concept of the new interactive internet show, Bump+, is certainly an interesting one. It is a self-proclaimed social experiment in which three supposedly pregnant women are followed for several weeks during the process of making a decision about what to do in the event of an unplanned pregnancy. Online viewers are invited to discuss each 5-ish minute episode and share their personal stories of unplanned pregnancies and reproductive choice. As the season progresses, episodes are crafted according to viewers, whose comments and stories will ultimately lead to a decision for each woman of whether to carry the pregnancy to term or terminate it.

Yellow Line Studios, the producing agency of the show, states that the purpose of Bump+ is to provoke a more open and productive dialogue around abortion in the hopes that "story can succeed where nearly four decades of angry rhetoric and political posturing have failed." While I am more than supportive of a mission to improve the discourse around reproductive rights, I have doubts about the capacity of this show to constructively promote discussion. I see that the show encourages viewers to put themselves in the shoes of women facing unplanned pregnancies in order to understand the complexity of factors such women contend with when trying to make a choice. However, I fear that even hypothetically placing a woman's reproductive choice in the hands of people other than the woman herself inherently undermines the concept of choice. Furthermore, the remarkably unrepresentative cross-section of pregnant women featured - three young white women in strenuous relationships - paints a dangerously specific picture of who faces unplanned pregnancies. This picture's expediency in galvanizing the public's sympathy could be at the expense of the many women who do not fit these cookie cutter models.

Will the dialogue inspired by this experiment contribute to a more (appropriately) nuanced understanding of the importance of reproductive freedom? Or will it instead detract from the ability of bystanders to respect the decisions that each individual woman, regardless of her circumstances, makes for herself? The answers to these questions are not readily apparent.

Of course, this is likely the point.

In any case, Bump+ merits a look from any and all interested parties. Conversation encouraged.

Abstinence education study must be considered with care

The public needs to be very careful about how it digests the newly released University of Pennsylvania study on abstinence-only education. ABC News, among other media agencies, such as the Washington Post, is pointing to it as "clear evidence that abstinence-only education works." But such a constricted study cannot be taken as "clear evidence" of anything, certainly not of abstinence-only education "working." When we talk about sex education "working," what do we mean, exactly? Does sex education "work" when fewer teens are sexually active at all? Or when they have less sex with fewer people? Or when they feel empowered about their choices? Or when they learn how to protect themselves from pregnancy and sexually transmitted diseases? Or when they learn how to gain practical access to those tools of protection? Such questions are critical to considering this data as an educated information consumer.

In any case, one cannot view these findings in a vacuum: they must be considered in conjunction with other persuasive national data, not instead. The study measures success as a decrease in sexually active 6th and 7th graders. This is a pretty narrow definition of success that leaves many students receiving this education out in the cold. While the study may be hopeful in suggesting that abstinence-only education in middle school decreases the number of sexually active pre-teens, it does not address the persistent concern of safer sex behaviors among those who do choose to have sex. Even after the decrease in sexually active middle schoolers described in this study, 33% still reported having had sex at least once. This means a third of pre-teens exposed to this education is left with no recourse to protect themselves. Furthermore, as these middle schoolers enter high school and more of the remaining 67% begin to have sex and find themselves in need of safer sex education, abstinence-only education becomes even less appropriate and more damaging.

If abstinence-only sex ed has a place anywhere in sex education, it makes its strongest argument with application to younger students, and even then it presents significant concerns. Its seeming success does not take away from the fact that sexually active youth are in need of education on safer sex behaviors so that they have the complete tools to protect themselves. Additionally, it must also be noted that the sample size in this study was very small and that it comprised primarily urban minority students, making it extremely difficult to meaningfully extrapolate to the larger population without follow-up research.

Give testimony on Women's Day at the Capitol

The Connecticut Permanent Commission on the Status of women is now seeking submissions for oral and written testimony at the February 9 Women's Day at the Capitol. This is an opportunity to tell Connecticut's Permanent Commission on the Status of Women what issues affecting women in this state are most important to you. Additionally, if you'd like to go to the capitol on Feb 9 to give oral testimony, this is an opportunity not only to voice your concerns but also to hear concerns of women across the state. For submission information, and to learn more about the CT Permanent Commission on the Status of Women, visit their website.

Bad call on Super Bowl anti-abortion ad, CBS

The Focus on the Family ad slated to air on CBS during the Superbowl is a disturbing demonstration of irresponsibility on the part of the network and a reminder of the power of money to advance ideology. The Los Angeles Times does a stellar job of outlining the policy changes and financial circumstances leading to CBS' decision to air the ad, as well as the emotionally manipulative content of the ad, which features Heisman Trophy winning quarterback Tim Tebow and his mother. Where is the network's integrity? Focus on the Family claims that they are running the ad because "families need to be inspired." But this supposed inspiration of families will also function as oppression of the millions of women in America who are watching the Super Bowl or whose family members are watching it, being impressed upon to imagine abortions as murdered future Heisman Trophy winners. Such manipulation is condescending and ignorant of the multitude of real-life dilemmas facing women from all walks of life during unplanned pregnancies.

Come on, CBS. You have all the lucrative options in the world for ads to air for that 30 seconds that don't condemn a woman's legal right to an abortion. I know football is traditionally a man's game, but bulldozing a woman's right to choose is not a play you can run or a show you can put on during halftime, no matter how popular a player your quarterback is. Have some guts: DON'T run the Focus on the Family ad next Sunday.

Join NARAL's effort to petition CBS not to run its ad by visiting the national website. Tell them why you think it's unacceptable to run an anti-choice ad during the most-watched TV event of the year, during which the ads are nearly as much of a draw as the featured program itself. Tell CBS to stand up for women, and for you.

Rise in teen pregnancy suggests flaws in sexual education policy

Teen pregnancy is rising in the U.S. after a decade-long decline, according to brand new data published by the Guttmacher Institute. This slow in decline and subsequent change in direction correlates with the adoption of the Title V abstinence-only education law from 1998-2009, which attached federal dollars for education to a strictly defined abstinence-until-marriage sexual education. While the classic statistical imperative charges that we not infer causation from correlation, it is difficult to ignore the implications of a federal law stating that sexual education programs who hope to receive federal funding must be "abstinence-only programs [that] have as their 'exclusive purpose' promoting abstinence outside of marriage" and that such "programs may not in any way advocate contraceptive use or discuss contraceptive methods except to emphasize their failure rates." The government financially rewards states that deny teenagers the tools to protect themselves adequately. This not only serves to validate such states' sex education agendas, but it also makes it extremely difficult for the state to change its policies. While at one time or another 49 out of 50 states accepted funds from Title V, half the states ceased participation. State Health Commissioner Dr. Richard F. Daines is cited on SIECUS stating his reasoning for New York's withdrawal from the program: “The Bush administration’s abstinence-only program is an example of a failed national health care policy directive… [the policy was] …based on ideology rather than on sound scientific-based evidence that must be the cornerstone of good public healthc are policy.”

The findings published by the Guttmacher Institute reveal differences in sex education policy indeed indicating that abstinence-based policies are not as functional as the writers of Title V hoped. The states with the highest teen pregnancy rates overall (New Mexico, Nevada, Arizona, Texas, Mississippi) are in the South and Southwest, and the states with the lowest (New Hampshire, Vermont, Maine, Minnesota) are in New England and the north Midwest. According to the Sexuality Information and Education Council of the United States (SIECUS), none of the states at the bottom require any sexual education at all. When schools in those states do choose to include education, state policy either follows the guidelines in Title V (only MS, currently) or stresses abstinence as much preferred over other sexual education (TX, AZ). These states also incorporate an opt-out policy, which allows parents to choose to exempt their children from sex education (NM), or an opt-in policy are required to give consent for the child to receive such education - making no sex education the default (NV). Conversely, the states with the lowest rates also have sexual education policies that significantly incorporate safer sex education and require all schools and students to participate.

These data also have startling implications for social justice. It seems like a cruel joke that those states which tend towards abstinence-centric sex education are also some of the poorest states in the nation whose public education systems are most in need of funding. There's nothing like putting strings on federal money to control the activities of poorly-funded education systems. Additionally, in the states with the highest rates, minority teens are taking a particularly hard hit. Those states report statistics (which generally reflect national averages) indicating that African American and Hispanic teenagers have significantly higher rates of teen pregnancy than white teens. In Maine, by contrast, which has one of the most comprehensive state mandated sex education programs in the country, the gap is almost nonexistent. Efforts to promote social and reproductive justice in the sex education and teen pregnancy arena would do well to take a closer look at sexual education as practiced in Maine's public schools. Again, causation cannot follow directly from correlation; but you have to start somewhere.