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Health

Promoting Abstinence Won’t Help Prevent Teen Pregnancy, But Funding More Youth Programs Will

Although teen birth rates are dropping, the United States still has the highest rate of teen pregnancy in the developed world. Particularly since American teens are often shamed about their sexual choices, rather than receiving the actual resources they need, the country has a long way to go when it comes to the way it approaches teen sexuality. The results from a new study underline the point that although abstinence education programs don’t work, a different focus on youth services can effectively lower the rate of teen pregnancies.

Researchers from University of Minnesota found that teenage girls at high risk for unintended pregnancy were more likely to take steps to lower their risk of becoming pregnant, like regularly using condoms and birth control pills, after receiving additional support from a youth-focused program. Over the course of their study, over 250 sexually active girls between the ages of 13 and 17 were split into two groups — about half were placed in a “Prime Time program” designed to help mitigate risky sexual behaviors by providing personal case management and youth leadership opportunities, while the rest of the teens didn’t receive any special counseling or support. Significant differences emerged in the teens’ sexual behavior:

All of the participants completed a survey two years after enrolling in the study. This was six months after the girls in the Prime Time intervention completed the program.

The girls in the Prime Time program reported “significantly more consistent” use of condoms, birth control pills or a combination of both types of contraception than those in the control group, the researchers found.

The girls in the Prime Time program also reported increases in family connectedness and self-confidence to refuse unwanted sex, as well as reductions in the perceived importance of having sex, the study authors noted in a journal news release.

Ultimately, as the study’s authors concluded, “health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth.” But those health services may not be widely available across the country — particularly in rural areas that tend to have conservative attitudes about sex, where teens may not feel comfortable seeking out the resources they need.

In particular, the 26 states that require health classes to push ineffective abstinence-only curricula — a misguided approach to sexual education that teaches adolescents to be ashamed of their bodies, rather than equipping young people with the tools they need to safeguard their health — would actually be better served by investing money in support programs for at-risk youth. If the U.S. reoriented its approach to teen sexuality, including acknowledging the fact that young men also have a role to play in preventing unintended pregnancies, the country could continue taking steps toward improving its relatively poor sexual health.

Health

Teen Pregnancy Is Most Common In Rural America, Where There May Be More Barriers To Birth Control

The teen birth rate is nearly one-third higher in rural areas of the United States than it is in more populous areas of the country, and teen pregnancy rates have been much slower to decline in rural counties over the past decade, according to a new study from The National Campaign to Prevent Teen and Unplanned Pregnancy. The advocacy organization notes that while no single reason explains the difference in teen birth rates across regions, adolescents in rural areas likely have particular barriers to contraceptive services.

“The prevailing stereotype is that teen parenthood is primarily an urban and suburban phenomenon,” Bill Albert, the chief program officer for the National Campaign, told USA Today. But the group’s new data suggests that’s not actually the case.

As the nation has increasingly focused its efforts on preventing unintended teen pregnancies, there has been significant progress. Although the U.S. still has the highest rate of teen pregnancy in the developed world, teen birth rates have plunged to record lows as adolescents have begun to use more effective forms of birth control when they become sexually active. But that trend has been slower to take root in rural areas. Between 1990 and 2010, the birth rate dropped 49 percent for teens in major urban centers and 40 percent for teens in suburban areas — but just 32 percent for adolescents who live in rural counties.

While teens across the country have largely been having less sex and using more contraception, teens in rural areas have actually been having more sex and using birth control less frequently. It’s not clear why that’s the case, but it could partly be because teens in rural areas still lack access to a range of comprehensive contraceptive services. There just aren’t as many sexual health resources in rural counties, where teens may have to travel farther to the nearest women’s health clinic. And deeply rooted attitudes about sex — including school districts that continue to cling to abstinence-only health curricula that don’t give teens enough information about methods to prevent pregnancy — may also play a role. Urban school districts, particularly in New York City, have made significant advances in expanding teens’ access to sexual education and resources, but there often aren’t similar pushes in rural places.

The United States’ culture of sexual repression has also created an environment where teen sexuality is stigmatized, and adolescents may feel too embarrassed to seek out the resources they need. The National Campaign points out that teens may feel like they can’t buy condoms in their rural town where everyone knows their name.

Health

Parents Tend To Be Uncomfortable With Giving Their Teens The Most Effective Form Of Birth Control

Intrauterine device (IUD)

The majority of parents want their teens’ doctors to be able to dispense birth control if they find out the adolescent has become sexually active — but, according to the results from a new study published in the Journal of Adolescent Health, parents’ comfort levels and the most effective methods of contraception are in direct conflict with each other. Just 18 percent of parents would be comfortable with their teen’s doctor giving them an intrauterine device (IUD), despite the fact that doctors actually recommend that long-lasting form of birth control as the first contraceptive that should be offered to young adults.

UC San Francisco researchers posed the following question to parents: “If your teen’s doctor found out your daughter was having sex, is it acceptable or unacceptable to you for the doctor to provide birth control to your teen confidentially?” Participants were asked to rank their comfort level with each contraceptive method — including birth control pills, condoms, emergency contraception, a birth control patch, or an IUD — on a scale from 1 to 4. Oral birth control had the most support from parents at 59 percent, condoms came in second at 51 percent, and Plan B got 45 percent. But the IUD ranked dead last, winning just 18 percent of respondents’ approval.

That could be because parents worry about IUDs having a lasting impact on their daughters’ fertility, an issue with the contraceptive method in the 1970s that is no longer a problem today. Adults may have also bought into the misguided idea that long-lasting birth control somehow gives license to promiscuity, since it protects against pregnancy for an extended period of time. But medical experts are working to dispel the stigma surrounding IUDs — the American College of Obstetrics and Gynecology already encourages doctors to offer teens long-lasting forms of contraception, since they’re the most effective way to prevent unintended pregnancies.

But even more generally, the results from the UC California study underline the fact that adults aren’t as comfortable with addressing teens’ sexual health as they need to be. “The lower than expected acceptability of condoms likely reflects parents’ overall low acceptability of contraception in general for their daughters,” the lead researcher of the study told the Atlantic. But considering the fact that U.S. teen birth rates remain much higher than the rates in other developed countries, it’s more important than ever that young adults across the country are able to access the reproductive resources they need.

And ultimately, the study speaks to larger societal issues surrounding sexuality, perhaps even unintentionally. The fact that researchers focused entirely on parents’ attitudes toward teenage girls, without addressing the fact that teenage boys also have a role in practicing safe sex and preventing pregnancy, reflects the fundamental gender-based imbalance in the way society approaches sex.

Alyssa

‘Downton Abbey’ Open Thread: Read The Signs As Best You Can

This post discusses plot points from the February 10 episode of Downton Abbey.

Last night’s super-sized Downton Abbey was a bit lumpy in places—the cricket match in particular felt like it might have been a richer subject several seasons down the line when we had a better sense of who actually lives not just upstairs and downstairs, but in the village. But the combination of two episodes that aired as individual hours in the UK let Downton ground Thomas’s story in a larger context of the ways in which sexual repression poorly serves men and women alike in 1920s England. As O’Brien conspires to lure Thomas to Jimmy’s room, Edith finds herself drawn to Gregson, and Matthew worries about his potential fertility, this episode was a reminder that, medically and socially, an inability to speak honestly about sex has terrible consequences.

Edith’s latest romantic adventures begin as professional ones. After Gregson writes her to inquire again after her availability as a columnist, she declares “I think I will go. It seems rude not to, in a way. And I haven’t been to London for ages.” Her family continues to be less than entirely supportive. As her grandmother puts it, “A woman’s place is in the home, but I see nothing wrong in her having some fun before she gets there. And another thing, Edith isn’t getting any younger. Maybe she isn’t cut out for domestic life.” But as it turns out, confining a woman to domestic life might also keep her from running across promising romantic prospects. When she and Gregson meet for lunch, Gregson admits to her “Am I allowed to say I’m pleased you’re not married?” “I’m a little less pleased,” Edith tells him. But she doesn’t leave the lunch and she takes the job—and she doesn’t quit it when Gregson remarks “You look very pretty today. I’m not sure how professional it is for me to point that out.”

It’s a relationship that brings out the best in both of them. Edith dares not just to write, but to take on subjects that no one would have expected her, like the lack of employment opportunities for soldiers returned home from the war, not all of whom are so lucky to amble into managing an estate, as Matthew has done. “I like the idea of a woman taking a position on man’s subject,” Gregson tells her. “I think we’re on to something new, here. The mature female voice in debates.” And it’s good for them personally—to a point. Edith comes out of her shell enough to enjoy a flirtation and to talk honestly about her experience being jilted. Gregson clearly enjoys her company as a colleague and as a woman. But when she inquires into his background, she discovered not just that he’s married, but how English law has inconvenienced him. Gregson is a decent man, but there’s something profoundly unfair about the law that shackles him to his wife because she’s too mentally ill to give consent to their divorce, and there appears to be no treatment that can make her well enough to set him free. Sir Anthony hurt Edith horribly because he couldn’t bear to tell her in a definitive way that he didn’t actually feel comfortable being with her. Gregson at least finds the courage to tell her the truth, but not after leading her down a disappointing path. What happens next may depend on how comfortable Edith feels defying convention. It’s one thing for her flighty cousin to convince herself a married member of the nobility is going to leave his wife for her, and another to go into a relationship like this one with your eyes open.
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Alyssa

‘Parks and Recreation’ Open Thread: Narrative Forms In The Digital World

This post discusses plot points from the February 7 episode of Parks and Recreation.

When you’re single, the most irritating person on the planet can be the dear friend who wants you to know that you’re so spectacular that of course everything’s going to turn out fine for you. That friend means well, but their encouragement only serves to highlight the gap in between what’s actually happening for you and what they insist should be happening, raising the possibility that a) you’re doing something wrong, b) there is a fatal flaw, c) the Gods have a sick sense of humor. And on last night’s episode of Parks and Recreation, that person was Leslie Knope.

On finding out that Ann is not just dating herself as a way to have new experiences and thinking about what she wants in life, but is considering having a baby with a sperm donor, Leslie declared “You’re definitely going to find a wonderful man who loves you, and respects you, and fills your home with multi-ethnic genius babies.” It’s a nice vision, but it was even nicer to see Ann put paid to Leslie’s relentless optimism for her best friend. “Maybe,” Ann told Leslie. “Or maybe not.” Either way, Leslie’s dream for her best friend is beside the point. Ann doesn’t want to wait anymore, she isn’t being diverted into a different path from Leslie’s, she’s just choosing it.

That’s both an exciting development for a character who can be passive and malleable with regard to her personal life, and as it turns out, a nice choice for the show’s larger universe. I’d been idly wishing for Crazy Ira and the Douche to Parks and Recreation, spurred in part by the debut of the Kroll Show on Comedy Central, so I was delighted to see Howard’s return to the show last night, as one of the candidates to donate sperm to Ann. And the show had a great joke for him: it turns out, to Leslie’s irritation, that he’s a relatively decent guy. “I majored in semiotics, wrote a thesis on narrative forms in the digital world,” Howard explained to Ann when she asked about his education. Leslie, still skeptical, wanted to know “Then you became a shock jock and created the sport taintball?” He shrugged it off, explaining “I know it’s a silly thing to do, but it pays the bills.” And later, he hit all of Leslie’s buttons when she tracked him down in the parking garage. “I’ve thought a lot about having kids. It’s the next big step in this grand adventure we call life,” Howard explained. “You know, if we had a little girl, I’d name her Elizabeth, after my grandmother. She was this strong, amazing woman.”
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Health

New York City’s Teen Pregnancy Rate Plummeted After High Schools Expanded Access To Plan B

The teen pregnancy rate in New York City dropped by 27 percent over the last decade, a statistic that city officials credit to teens’ expanded access to contraception.

The city’s health commissioner, Tom Farley, told the New York Daily News that the data shows two concurrent trends: more adolescents are choosing to use birth control, and more of them are also delaying sexual intercourse. That’s partly because New York is one of the 21 states that allows all minors to have access to contraceptive services — and two years ago, the public school system began a pilot program to provide Plan B to public school students in districts with high rates of unintended pregnancy:

The city has worked to make it easier for kids to get birth control — giving out condoms at schools and making birth control and the morning-after pill available in some school clinics, a sometimes controversial move.

Farley said the numbers show that strategy is working.

“It shows that when you make condoms and contraception available to teens, they don’t increase their likelihood of being sexually active. But they get the message that sex is risky,” he said. [...]

Teen pregnancy in the city is still higher than it is nationwide, but it has fallen at a sharper rate, officials said.

Despite the promising trends, health officials in the city note that there are still significant racial and geographic disparities among the teens who are getting pregnant. The Bronx has the highest rate of teen pregnancy in the country, and African-American teens in New York City have a much higher pregnancy rate than their white counterparts — 110.7 births for every 1,000 back girls, compared with 16 births for every 1,000 white girls. That trend is evident on a national level, too. Black and Latina women have the highest rates of unplanned pregnancy and, subsequently, the highest rates of abortion.

But the city’s school system is on the right track, since part of addressing the connection between poverty and teen pregnancy is increasing access to affordable birth control. Removing the cost barriers to contraception encourages low-income women to choose longer-lasting, more effective forms of birth control that lower their risk for unintended pregnancy. And increasing adolescents’ access to Plan B is particularly important since the Department of Health and Human Services requires women under the age of 17 to obtain a prescription for Plan B, an unnecessary extra step that is often a barrier preventing adolescents from accessing the contraception they need in a timely manner.

Despite right-wing fervor over Plan B, it is an extremely safe medication that does not actually induce abortion. The majority of parents whose children are enrolled in New York City’s public schools support the city’s initiative to expand access to this type of contraception.

Alyssa

‘Downton Abbey’ Open Thread: Ladies and Newspapers

This post discusses plot points through the January 27 episode of Downton Abbey.

I was on the road when the January 20 episode of Downtown Abbey aired, so this week, I’ll consider both hours of television together. And while the show does have a tendency to skip around—in time, in location, in tone and quality—these two episodes, taken together, offer up a strong illustration of the difficulties of making yourself heard, whether it’s across the gender barrier, upwards across class lines, or through an arbitrarily-imposed bureaucracy. The consequences of those enforced silences, as we saw this weekend, are fatal.

Anna and Bates’ story has fairly definitively stalled out for me at this point in Downton Abbey‘s run, but Bates’ stint in prison has been a nice little parallel to events at Downton itself. He’s a different kind of downstairs now, bound by a different set of social constraints. Inmates have different routes to influence than they did in the big house, where service to one of the principals of the household gave them direct access to air their opinions, if they were carefully stated. And the principals of the household had been raised from childhood to be used to having power, and to exercising it in certain ways, whether it’s to smooth the advancement of certain members of the household staff within the house, or to make interventions in their health and welfare outside the realm of service, as with the surgery for Mrs. Patmore’s contacts or Cora’s promise that Mrs. Hughes would be provided for even if cancer treatment failed to prove effective. But in prison, the guards and wardens are new to power and are primarily concerned with aggregating it. Where the Downtown residents’ acts of kindness to the people they have power over don’t constitute a wholly reliable social safety net or engine of upward mobility, they at least provide a reliable set of cues about incentives and rewards. In prison, something like the withholding of Bates’ letters is meant to enforce the arbitrary nature of his position, to encourage him to be utterly cowed lest he break an unwritten rule or violate a norm. It’s yet another one of Downton‘s reminder that however limited the opportunities are for people in service, falling out of that hierarchy can be even worse.

But it’s one thing to fall out of a hierarchy that provides you with a minimum of status, and another to reach the top of your privilege and find that some of the marginal gains aren’t worth the sacrifice that goes along with them. After Lady Edith found herself jilted at the altar and committed herself to a useful spinsterhood, I emailed a friend that I thought she might break out of society’s role for her, albeit in a more sedate way than Sybil had by eloping. Some of her initial changes are small. “Why don’t you have breakfast in bed?” Matthew asks her when she comes down to dine with him and Lord Grantham. “Because I’m not married,” Edith tells him shortly. It’s a position that provides her with some embarrassment, but it also puts her in the position of being the lone young woman in company with the men of her household, and in a position to voice frustrations about things like suffrage. “I don’t have the vote,” she tells Matthew, bitterly. “I’m not over 30 and I’m not a householder. It’s ridiculous.” His suggestion that she write to the Times may be flip, but it’s certainly more productive than Lord Grantham’s reminder that Edith really ought to talk to Cora about how she can help with the evening’s dinner. The Dowager Countess may tell Edith that “You’re a woman with a brain and reasonable ability. Stop whining, and find something to do,” but I don’t know if she recognizes that dinners and local charitable patronage still might leave Edith empty.

And so there’s something tremendously exciting about seeing Edith take Matthew’s advice, and for once, get rewarded for making extra effort by the Times, if not by her family. “No lady writes to a newspaper,” Violet declares, before amending that statement to remind Edith that one who does is “A Churchill. The Churchills are different.” Cora tells Edith that “It’s good to have strong views, but noteriety is never helpful.” In other words, Edith is entitled to her feelings, but not the exercise of them, and should accept her gilded cage. And when the letter is published, under the title “Earl’s Daughter Speaks Out For Women’s Rights,” Edith may still be categorized by her relationship to her father, but for once, she’s using that power to get what she wants, instead of letting it define her sphere of influence. So what if “That’s what he’s buying, your name and your title,” as Lord Grantham puts it: Edith is getting something out of the bargain, too.

And as it turns out, “the problems faced by the modern woman rather than the fall of the Ottoman Empire,” aren’t an “even so.” They become urgent when Sybil goes into labor and Lord Grantham quashes the voices of women and Dr. Clarkson when it comes to their care, opting for class and gender solidarity instead. It’s awful to hear Lord Grantham say “I don’t want to hurt Sir Phillip’s feelings,” as if that were the most important issue at stake here, even when it seemed like Sybil’s delivery would go normally. And it’s worse to find out that Sir Phillip is essentially in agreement with Lord Grantham on the importance of his own expertise and status. His snapping at Dr. Clarkson, who has know Sybil her entire life, “Maybe she has thick ankles. Lots of women do,” is the Downton equivalent of advocating an aspirin between the knees as a contraceptive. It’s a refusal to see Sybil as a specific person, and to embrace the actual practice of medicine in favor of the performance of sagacity. And it kills her.
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Alyssa

Three Stories To Watch On The Duchess of Cambridge’s Pregnancy

As someone who has read Tina Brown’s The Diana Chronicles more times than I care to admit, and who harbors a streak of deep and abiding corniness, will confess to being happy at the news that the Duke and Duchess of Cambridge are expecting their first child together. But it’s not just the Royals-watcher in me that’s curious to see how Kate Middleton’s pregnancy plays out. Here are three things I’m thinking of as the media frenzy commences:

1. How will her pregnancy affect the ongoing debate over British press laws? When Princess Diana was pregnant, Queen Elizabeth made a special appeal to the press to consider how they treated the Princess of Wales, given how badly she was suffering from morning sickness, an affliction that also appears to plague her daughter-in law. This time, Kate Middleton’s pregnancy comes in the middle of an event that could put even more pressure on British publications: the release of the Leveson Report into the phone hacking scandal that proposed a much more rigorous regulation scheme for the British press. How British tabloids pursue the Duke and Duchess of Cambridge could end up affecting public sentiment about the Leveson recommendations.

2. It’s crazy-retro to have your job be getting pregnant, but at least that recognizes that pregnancy is work: Usually, we’re uncomfortable discussing the extent to which being pregnant is hard work until it comes to giving birth: then, we call the process labor. Some informal rituals have sprung up to acknowledge the physical work that goes into carrying a child, like the idea of so-called push presents for a partner who’s given birth (the all-time best of those? The biker boots Tim Burton gave Helen Bonham Carter after the birth of their fourth child.). We’re comfortable with the idea that surrogates should be compensated (and we don’t treat them like insane throwbacks, in part because surrogacy isn’t usually a full-time job). But all of these conversations still shy away from the nine-plus months of work that happens before a woman goes into labor, and for state support for women whose pregnancies aren’t as high-profile affairs as the Duke and Duchess of Cambridge’s. The United States is the only Organisation for Economic Co-operation and Development member country that doesn’t mandate paid parental leave schemes for new parents. It may be insanely old-fashioned for a woman to have as her career goals having two children. But at least when she does, everyone recognizes that she should get totally comprehensive, affordable health care coverage.

3. Boys are no longer the prize: I wrote about this earlier today, but for the first time, a Royal pregnancy doesn’t have to produce a boy to be successful. If Kate has a girl, she gets to be Queen, period, without any worry that she’ll be leapfrogged by a younger brother. That’s awesome, and shockingly overdue.

NEWS FLASH

U.S. Birth Rate Drops For The Fourth Year In A Row | There were fewer than 4 million births in the U.S. last year — the lowest number since 1998 — making it the fourth year in a row where the nation’s birth rate decreased. The 1 percent decline was not as steep of a drop compared to recent years, but the birth rate for Hispanic women dropped 6 percent and the teen birth rate continued to fall to a new record low. In a statement, Planned Parenthood officials contributed the decline in teen births to teenagers using better forms of birth control.

NEWS FLASH

Senate Introduces ‘Pregnant Workers Fairness Act’ | Sens. Bob Casey (D-PA) and Jeanne Shaheen (D-NH) introduced the Pregnant Workers Fairness Act to the Senate today. The bill would offer workplace protections for pregnant women, requiring employers to provide reasonable accommodations to pregnant employees. Such accommodations include providing a stool or water bottle to a pregnant worker, or allowing her not to carry heavy boxes — measures that ensure pregnant workers don’t have to put their health at risk, or leave their jobs before they need to. The legislation was introduced in the House in May, but has since made no advancements.

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