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The Answer Blog

Archive for August, 2011

No Co-Pays for Women’s Health Care: Better But Not Perfect

August 9, 2011

Birth controlIn a groundbreaking move, the U.S. Department of Health and Human Services announced last week that, as part of the Affordable Care Act, it would for the first time ever require new health insurance plans to include coverage for the costs of a wide range of preventive health services for women without co-pays. At Answer, we were particularly delighted to see sexually transmitted disease (STD) counseling, HIV counseling and testing, and FDA-approved contraceptive methods included on the list of preventive services. Finally, an administration that has elevated the health needs of women and their families to where it needs to be!

I truly do believe this decision is unprecedented. At the same time, however, having worked in the nonprofit sector for nearly 25 years, my social justice autopilot is permanently set on “who’s missing?” So when I read the announcement, the first question that came to my mind was, “What about all the people who do not have health insurance?”

In 2010, 39 percent of people ages 64 and younger had no health insurance, according to the Centers for Disease Control and Prevention (CDC). This is the highest rate since 1997. That translates to roughly 48 million people. Hispanic and African-American individuals were, as always, disproportionately represented among those who did not have insurance. And when the CDC says “uninsured,” that means no private health insurance, Medicare, Medicaid, Children’s Health Insurance Program, state-sponsored or other government-sponsored health plan or military plan. Unfortunately, none of these people would benefit from the Affordable Care Act’s provision.

Historically, uninsured individuals could go to their local family planning organization for their health care needs, but not any more. Not when more and more state governments continue to irresponsibly eviscerate the funding budgets for those organizations, many of which are the only places women and men go to for their health needs. This remains one of the biggest oversights and tragedies of the conservative agenda to eliminate family planning services. In doing so, they are often eliminating the only health care some people will ever have access to or receive. And the fewer preventive services that are available, the higher the cost down the line for treatment and care for the illnesses that can result—for women AND men. See, according to the HHS announcement, “Women are more likely to need preventive health care services.” But according to the CDC, boys and men are more likely than girls and women to be uninsured. This issue affects everyone, regardless of gender or age.

So as we celebrate this bold move—and truly, we must—we cannot rest on our laurels for very long. We must remember that well-woman visits are invaluable for early detection, diagnosis and treatment of illnesses for which the uninsured remain disproportionately at risk simply because they do not have access to these services. We must remember that at the same time that well-woman visits are imperative, so too are preventive and well-care services for boys and men. And in the same breath with which we celebrate victories like this, we need to remember those who are habitually forgotten and neglected, and whose lives can be made or broken based on politics and reckless cuts to invaluable programs and services.

Beyond a Public Health Model of Sexuality Education

August 3, 2011

In her recent blog for RH Reality Check, “A Collision of Culture and Nature: How Our Fear of Teen Sexuality Leaves Teens More Vulnerable,” former U.S. Surgeon General Dr. Joycelyn Elders states, “Efforts in the United States…to address adolescent sex have been directed toward preventing teenage sex as opposed to understanding helping teens prevent adverse consequences of sexual activity.” She makes an impassioned argument for comprehensive sexuality education K-12, and I could not agree more.

Lois teaches sex ed
Family Guy

At the same time, however, Dr. Elders’ piece reinforces how much the field of sexuality education remains stagnated in an almost exclusively public health model that depersonalizes the learners we are trying to serve. We focus on reducing teen pregnancies and births, lowering STD rates and learning how to use various safer sex and contraceptive methods accurately and effectively, which are invaluable components to effective sexuality education and to helping young people grow into healthy, complete adults.

Yet these goals are nowhere near enough. We need to do a much better job of explaining to the general public what sexuality education K-12 really means, and this means not couching our goals and objectives exclusively in reducing pregnancy and STDs. Failure to communicate what sexuality education K-12 really means is a significant reason why our efforts to provide age-appropriate sexuality education in younger grades does not resonate with more adult professionals and parents. Adults tell us, “If the overall goal is preventing something that happens as a result of sexual behaviors, that means you are going to teach my kindergartener about sexual intercourse.” Opponents to the work we do have exploited that unfounded fear very effectively—and unnecessarily.

The world needs to understand that just like any other topic area, sexuality education must start early with very basic information that supports the creation of an overall healthy person. The world needs to understand the myriad topics that, on face value, seem to have nothing to do with sexuality, but are imperative in order to become a sexually health adult. For example, when we teach a kindergartener how to be a good friend or about boundaries of any kind, we are establishing the foundation that later will help them to be a good partner. When we tell a child, “hands are not for hitting,” we are setting the stage for our later lessons on healthy versus abusive relationships. When we teach them to negotiate with each other rather than just grabbing a toy from another student or running away from a frustrating situation in tears, we are helping them learn to communicate. When we teach young children how to take care of their bodies and to wash their hands to avoid infections, we have laid the cornerstone for later lessons on puberty, sexually transmitted diseases and more.

We seem to understand this in every other topic area—except for human sexuality. Consider math, for example. Young people tend to learn algebra in the 9th or 10th grade, because that’s the age at which their brains can understand algebra. Yet we do not begin teaching math in the 9th or 10th grade, because we know that students need the foundational knowledge of addition, subtraction, multiplication and so on before they can understand and apply the knowledge they received during algebra class. Why on earth should a life-enhancing, lifesaving topic like human sexuality be any different? And yet it is. In many schools nationwide, if sex ed is taught, it begins in high school and makes assumptions that by osmosis young people enter high school with the foundational knowledge and skills they need, but rarely have.

Sexuality education must start earlier, and it must be framed much more effectively as part of creating an overall healthy person—only one component of which is determining whether and when to become sexually active, and how to protect themselves and their partners from infection and/or pregnancy.