Rutgers, The State University of New Jersey




login / register  arrows

The Answer Blog

Archive for March, 2009

Childbirth: More Difficult Than You Think

March 27, 2009

If you were to ask teens in a sex education class about childbirth in America, most would agree that it is a relatively safe and easy procedure with practically no side effects. But childbirth is not nearly as risk-free in other places, especially in Ethiopia, Tanzania, and other countries in sub-Saharan Africa.

A devastating factor called an obstetric fistula can wreak havoc on young and adult women who give birth in poor, rural countries that lack doctors and nurses, sanitary facilities, roads, and methods of transportation.

A recent article in Science Times provides an excellent explanation of an obstetric fistula. Times reporter Denise Grady describes how a fistula develops after women experience complications during childbirth: “Obstructed labor can kill the mother [and baby] or crush her bladder, uterus, and vagina between her pelvic bones and the baby’s skull. The injured tissue dies, leaving a fistula: a hole that lets urine stream out constantly through the vagina. In some cases, the rectum is damaged and the stool leaks out.”

Young girls ages 13 to 17 are most vulnerable to obstetric fistulas. They are often married off soon after their first menstrual period, usually to older men in the community, and because of poor diet and nutrition, their bodies and bones are not strong enough to withstand normal labor. Exacerbating the problem, most of these young women live in rural areas—miles, hours, and even days from an urban medical clinic or hospital—and there is no transportation other than dusty carts and ancient buses to take them where they can have a safe delivery. There is no help when these women go into prolonged labor. The baby usually dies in their uterus and they develop fistulas.

Unless the fistulas are repaired by skilled surgeons, these young women leak urine and feces through their fistulas, some continuously. Most are ostracized from their homes and villages and often forced to live in huts they have made themselves. If married, their husbands usually leave them to marry another woman.

The only consolation to this terrible problem is that the operation to close the fistula is 90-percent effective. Grady reports that a charitable group—the African Medical and Research Foundation—brings skilled surgeons to Dodoma, Tanzania, to operate and train doctors and nurses from other places in Africa on how to repair fistulas.

But the person who’s done the most to shed light on the fistula/childbirth problem, and to bring help to young African woman, is 83-year-old Australian obstetrician/gynecologist Dr. Catherine Hamlin. She and her late husband, Reginald, also a surgeon, emigrated from Australia to Ethiopia more than 45 years ago to start a school of midwifery. Instead, after seeing the fistula problem, they pioneered the first operation to repair them and opened the first and only world center dedicated to providing free fistula repair, the Addis Ababa Fistula Hospital.

Hamlin tells the story of founding the hospital and the Fistula Foundation, which raises funds to support and expand its work, in her book The Hospital by the River.

The Fistula Foundation released a DVD, A Walk to Beautiful, that is tailor-made for high-school classroom use. This unforgettable film runs over an hour and is divided into six sections, which makes it very appropriate for classroom viewing and discussion. (We will give away a free copy of the video to the first five educators who comment on this post!)

Why should we talk about the problem of obstetric fistula among African women in our classrooms? Studying childbirth in places like sub-Saharan Africa might make our students more appreciative of the great progress we’ve made in medicine in the U.S. Some may become more understanding of international health problems, more empathetic about the needs of teens in poorer parts of the world, and more willing to contribute to others’ well being.

A high school health class might decide to hold a car wash or bake sale to raise funds for Addis Ababa Fistula Hospital. A student might be so inspired by the film that he or she might become an ob-gyn and spend a part of his or her life repairing fistulas and educating young women about their dangers in one of Dr. Hamlin’s hospitals.

Now that indeed would be beautiful.

Why Can’t More Americans…?

March 25, 2009

In the hit Broadway musical and movie My Fair Lady, Professor Higgins sings plaintively, “Why can’t a woman be more like a man?” The lyrics came to mind recently as I found myself vexed by several national media stories that reveal our negative attitudes about sex. Yet my plaintive question is: “Why can’t Americans be more accepting of their sexuality?”

Story 1: Anna Quindlen on Abstinence-Only

If Americans were more accepting of their sexuality, Newsweek columnist Anna Quindlen might never have had to write these sentences in her March 16th column:

“Texas leads the nation in spending for abstinence-only programs. It also has one of the highest teen birthrates in the country. Those two sentences together sound like the basis for a logic question on the SAT, but a really easy one.”

Quindlen writes a brilliant, perceptive analysis of Congress’ blindness to the failure of abstinence-only programs. If we, as a country, were more accepting of our sexuality and more willing to follow sound program evaluation, we’d have decided years ago that all young people deserve comprehensive sexuality education and be done with it.

Story 2: Obama’s Budget and Abstinence-Only

Sexuality educators learned that the new administration hasn’t removed funding for abstinence-only-until-marriage programs. Sure, it may have cut some of the money, but the Department of Health and Human Services section devoted to Preventing Teen Pregnancy states:

“The Budget supports State, community-based, and faith-based efforts to reduce teen pregnancy using evidence-based models. The program will fund models that stress the importance of abstinence while providing medically-accurate and age-appropriate information to youth who have already become sexually active.”

I call this budgetary decision a big waffle that divides kids into two groups: the sheep (the “good” kids who don’t have sex while in high school), and the goats (the “bad” kids who do). It denies young people equal opportunity to learn in advance of having sex about important ways to prevent unintended pregnancy and sexually transmitted disease.

Isn’t it useful for kids who decide to remain abstinent in high school to have knowledge about contraception, which they might put to use when they are in college or, as adults, ready to get married or commit to long-term partnerships?

If only Americans were more accepting of their sexuality, the DHHS would fund programs that offer balanced information about abstinence and contraception before most kids become sexually active. And it would support distribution of condoms and birth control pills to those who ask for them, as is done in many European countries with far lower teen pregnancy rates than ours.

(more…)

Sex Education: Forgotten, or Ignored?

March 11, 2009

It always amazes me how frequently the phrase “sex education” is omitted from important articles or statements about reproductive health, family planning and abortion. Sexuality education plays a crucial role in prevention, and it deserves much more recognition than it receives.

Just consider these two recent examples from the national press:

The National Council of Catholic Women recently bought a full-page advertisement in The New York Times. The ad reproduced a statement on the Freedom of Choice Act by Cardinal Francis George, of Chicago, who is president of the United States Conference of Catholic Bishops (USCCB).

The Act, if passed, would ensure Roe v. Wade’s protections and guarantee a woman’s right to choose. The statement from the USCCB was a stinging attack on the Act, and it included no mention of efforts the USCCB would support to reduce the number of abortions in the U.S.—not even a reference to abstinence-only programs. The USCCB focused on how the Act would threaten “prenatal human life,” rather than on ways that we, as a nation, can work together to reduce the number of abortions. Comprehensive sexuality education provides such a way.

The second example is the Times op-ed “This Is the Way the Culture War Ends,” by William Saletan. Saletan, Slate’s national correspondent and author of Bearing Right: How Conservatives Won the Abortion War, presents his solutions on ending the culture wars that currently rage over abortion, same-sex marriage and birth control.

On birth control, he writes:

“This isn’t [about] a shortage of pills or condoms. It is a shortage of cultural and personal responsibility. It is a failure to teach, understand, admit or care that unprotected sex can lead to the creation—and the subsequent killing, through abortion—of a developing human being.”

Now you may consider me naïve, but I was certain that Saletan’s next sentence would be about the importance of high quality, balanced sexuality education in our pubic schools.  But, you guessed it, he simply moved on without mentioning any instruction that might help young people understand the concept of personal responsibility about sexual behavior.

Maybe Saletan hasn’t heard a crackerjack high-school educator instruct students about the need to use contraception each and every time they decide to have sex, or if they one day decide not to be abstinent. Perhaps he doesn’t understand that for years and years, young people in the majority of states have only been given negative or false information about contraception through federally support abstinence-only programs.

Perhaps what Saletan wants all educators to tell students is “abortion kills a developing human being.” He apparently won’t settle for educators saying, “Most people believe that abortion is killing a developing human being, but some people believe otherwise.”  A balanced statement like this wouldn’t detract from Saletan’s point that students need to learn about, discuss and understand the importance of taking personal responsibility, when or if they have sex.

To his credit, Saletan breaks with traditional Catholic doctrine by saying that a “culture of life requires an ethic of contraception” and that birth control offers people “a loving, conscientious way to prevent conception…” I just wish he had added, “Public schools with students of all different religious denominations should teach about birth control in their sexuality education classes.” Period.

That would have made me happy—that, and a land where the phrase “sex education” is as commonplace as Mom and apple pie.

A Panel of Palins

March 5, 2009

Let’s give credit where it is due: I am pleased that Bristol Palin and her mother, Sarah Palin, the Alaskan Governor and former vice presidential candidate, are speaking out about the birth of Bristol’s son, Tripp. Tripp was born two months ago when Bristol was barely 18. His parents are still in high school and, although engaged, have no immediate plans to marry.

Hurrah for Bristol and the governor for telling Greta Van Susteren of FOX that they are now opposed to abstinence-only-until marriage (AOUM) education in public schools.  (See video of the interview below.) Governor Palin calls abstinence-only “naïve,” and her daughter, although saying everyone should be abstinent, calls it “not very realistic.” These are small steps in the right direction.




It would be great if Sarah Palin and Bristol wrote to the president, their senators and congressperson and asked them to remove funding for AOUM from the federal budget. The unplanned pregnancy that brought little Tripp into the world is a perfect example of the results of incomplete sexuality education for teens.

Given her interview with Van Susteren, it’s clear that Bristol is willing to become the celebrity poster gal for preventing teen pregnancy. (The U.S. has the highest teen pregnancy rate among Western industrialized nations, although it has plummeted in the last decade.) Bristol told Van Susteren, “I’m not the first person that it’s happened to, and I’m not going to be the last.” Later, she added: “Kids should just wait. . . . It’s not glamorous at all.”

I combed a recent People magazine article about Bristol to see if she was going to say something more substantive beyond, “I hope that people learn from my story.”  She added that it was her decision to have the baby, not her mother’s, and that she wishes she had gotten an education and “started a career first.”

However, her message is contradictory, as are most messages when they involve unplanned births; she also told People, “He…brings so much joy. I don’t regret it at all.”

I think Bristol should appear as part of a panel of teens who have been affected by teen pregnancy. For example, consider a panel composed of Palin and teens who’ve had the following experiences:

  • a teen girl impregnated by an older man;
  • a teen girl whose family is entirely supportive of early child bearing;
  • a teen girl who has chosen abortion with her parents’ support;
  • a teen dad who had to drop out of school to work in a dead-end job; and
  • a teen who is having sex but using reliable contraception.

This “panel of Palins” would represent different races, ethnicities and classes and would answer all questions put to it by a teen audience. Teens’ questions would be written anonymously and placed in a large Question Box on a table onstage. A trusted faculty person or student would read questions aloud, without embarrassment or editing, to the panel for answers.

My hope is that such a panel would get to the heart of the matter about why and how teens get pregnant and have babies while still in high school. Bristol Palin can really make a difference if she tells the truth and doesn’t gloss over details. She will need to be exceptionally honest and not mouth platitudes such as, “I wish I had waited.”

Bristol needs to tell her peers about the failures of abstinence-only and the importance of using contraception. She can always make a pitch for remaining abstinent, since many teens choose this route. But she also needs to explain how important it is to talk to parents about sex and urge students to use good teen sexual health Web sites like Sexetc.org.

I don’t envy Bristol the role of becoming the nation’s poster teen for pregnancy prevention. But if she does it well, she could make a real difference. This coming May is teen pregnancy prevention month. Bristol and her potential panel members don’t have a moment to lose.